The perspective within which these existential practices and understandings are framed is a pluralistic one. Pluralism is a way of thinking about therapy that has emerged in recent years (Cooper & McLeod, 2007, 2011b; McLeod & Cooper, 2012; McLeod, McLeod, Cooper & Dryden, 2014; Milton, 2010b). It is based on the philosophical assumption that ‘any substantial question admits of a variety of plausible but mutually conflicting responses’ (Rescher, 1993: 79). In other words, pluralism assumes that many different things can be ‘right’, and that it is often more constructive to allow multiple truths to flourish than to try and pin things down to a definitive single answer. This is particularly the case where questions are ‘substantial’, and nowhere is this more true than in questions of human being, functioning and therapeutic change. In relation to therapy, therefore, a pluralistic perspective suggests that there are lots of different ways of understanding why people get distressed, and lots of different ways of helping them. That is, no one therapeutic approach – existential or otherwise – has the monopoly on understanding the causes of distress or on the most helpful therapeutic responses. Such a stance challenges the schoolism that has been endemic in the therapy world (Cooper & McLeod, 2011b): that only Therapy X explains why people get distressed, or that only Therapy Y can help them. Instead, it argues that therapists should be open to respecting understandings and practices from across the counselling and psychotherapy field.
In this pluralistic approach, there is also an emphasis on acknowledging and appreciating diversity across clients, and recognising that different clients may benefit from different therapies at different points in time. As Boucher (2010: 159) writes, ‘the basic tenet of pluralism is very simple – there are many people and they are all unique.’ Hence, the approach is about trying to tailor the therapeutic approach to the individual client. It is about ‘horses for courses’ rather than ‘one size fits all.’
These two basic principles of pluralism – that clients can be helped in many ways and that it is good to talk to them about what they want – can be held by therapists of any orientation. Therapists do not need to draw on practices from multiple orientations to do so. For instance, a therapist may choose to practise in a purely existential way, but at the same time appreciate the work that cognitive-behavioural and psychodynamic therapists do. However, this pluralistic perspective opens on to the possibility of pluralistic practice: drawing on multiple understandings and methods in the therapeutic work. A pluralistic approach also suggests that therapeutic effectiveness may be enhanced if practitioners draw on knowledge from multiple domains: personal experience, theory, practice and research. This last one has been particularly emphasised within the pluralistic approach (e.g., Cooper & McLeod, 2011b) because it has, traditionally, been neglected in the training of counsellors and psychotherapists (see, for instance, Morrow-Bradley & Elliott, 1986). In this respect, a pluralistic perspective advocates an evidence-informed approach to therapy: where evidence is treated as one – but just one – very valuable source of information on how best to help clients. (For a detailed discussion of the relationship between research and existential therapy, see Cooper, 2004c.)
Box 1.1 The pluralistic approach: FAQs
Does a pluralistic approach mean that you have to be able to offer every therapy going?
No, as indicated above, you can hold a pluralistic perspective without necessarily drawing on multiple therapeutic understandings and methods. Even if you do, no-one would ever be able to offer the 400+ therapies going, and it is an important ethical requirement that therapists have adequate training in whatever therapy they choose to offer. So pluralism is not about trying to do a bit of everything. It is about being open to the value of multiple practices and understandings, and drawing on them as and when the therapist might have the appropriate expertise, and as and when that might be helpful to the client.
Isn’t pluralistic therapy just the same as integrative/eclectic therapy?
There is certainly a lot of overlap, and in many ways pluralistic practice – where a therapist is drawing on two or more approaches – can be considered synonymous with a ‘collaborative integrative’ way of working (van Rijn, personal communication, 2013). However, there are three important distinctions between a pluralistic approach and integrative practices (putting together different theories, Hollanders, 2014) or eclectic practices (selecting techniques from a number of different orientations irrespective of the underlying philosophies, Hollanders, 2014), per se. First, in many instances, integrative or eclectic models of therapy are particular combinations of therapeutic understandings and practices – such as Cognitive-Analytic Therapy (CAT, Ryle, 1990) – while a pluralistic approach refers to a more general openness to multiple therapeutic perspectives. Second, while many integrative and eclectic approaches do put considerable emphasis on shared decision making and a tailoring of the therapeutic work to the individual client (see, for instance, Lazarus, 1993), this is not inherent to either approach. Third, integrative and eclectic are descriptions of particular ways of practising therapy while, as we have seen, pluralism can also refer to a particular stance towards therapy as a whole.
Aren’t we all pluralists anyway?
It is undoubtedly true that many counsellors, psychotherapists and psychologists do, already, think and practise in ways that we have come to describe as ‘pluralistic’. Indeed, in a recent study of American psychotherapists, at least 98% identified with more than one therapeutic orientation (Cook, Biyanova, Elhai, Schnurr & Coyne, 2010). Pluralism, then, is less a ‘shiny new’ form of therapy, and more an articulation of what many therapists have thought and practised for years. Nevertheless, formally articulating it gives us the opportunity to research, develop and promote this way of working.
Most clients don’t know what they want from therapy, or how to go about getting it, so why ask them?
Actually, in our experience, most clients are pretty able to say what they want from therapy, and offer some ideas about how they might get there (Cooper, 2014; Cooper et al., submitted). Even if they cannot, inviting clients to do so at the start of therapy seems to help them feel more able to say what they want or prefer later on in the work.
If you just give clients what they want, aren’t you in danger of ‘colluding’ with them?
Shared decision making is not about just doing whatever clients want. It is about involving them in the process of dialogue, and trusting that they – as well as the therapist – have something useful to contribute to this process. So if a therapist thinks that what a client wants is unhelpful or unreasonable, this is something they should bring into the dialogue. In this respect, a pluralistic approach does not imply an uncritical acceptance of the client’s perspective, but neither does it allow for its uncritical negation (Borrell-Carrio, Suchman & Epstein, 2004).
So does that mean you can still work with the ‘transference’?
Yes, but a pluralistic approach would aim to make this explicit and agreed at the start of therapy, so that there is consent from the client to do so.
Surely clients’ goals and preferences for therapy change, so the ones that they first think of are not necessarily the ones that they will prioritise later on in therapy?
Exactly, so a pluralistic approach emphasises the need to continue dialoguing with clients about goals and methods as the therapy develops, not just as a one-off event.
Where can I find out more about the pluralistic approach?
An introduction to pluralism is available on the companion website. See also www.pluralistictherapy.com and Recommended reading at the end of this chapter.
An Introduction To Pluralism
