Constructivist Psychotherapy

Distinctive Features

Robert A. Neimeyer

• Publisher: Routledge
• Year: 2009
• Print ISBN: 9780415442336
• eBook ISBN: 9781134107834
• Topic: Psychology
• Subtopic: Cognitive Psychology & Cognition
• Index: Psychology

Constructivist psychotherapy focuses on the meaning that clients attribute to their world, and the way that this shapes their life and contributes to their difficulties. In this book, Robert A. Neimeyer, a leading figure in the field, provides a clear and accessible explanation of the key features of this approach.

Constructivist Psychotherapy: Distinctive Features concentrates on the 30 key commitments that distinguish constructivism from other cognitive behavioural perspectives. Divided into two sections – Theory and Practice – this straightforward book is illustrated throughout with case material and recent research findings.

Neimeyer provides us with a fresh perspective on familiar material, together with a clear, concise introduction to material that the reader may be less familiar with, making this book a valuable text for professionals in training as well as a source of new ideas for practising therapists of constructivist psychotherapy.

Part 1
THE DISTINCTIVE THEORETICAL FEATURES OF CPT

No intellectual development arrives on the scene as a result of the “immaculate conception” of its founder. Instead, each inevitably arises from the commingling of concepts from previous generations, representing the fertile marriage of ideas having different intellectual pedigrees. Extending this “marriage” metaphor, we might even say that every nascent theory represents “something old, something new, something borrowed, and something ‘true’”—at least to its adherents! In other words, every emerging perspective repackages the wisdom of earlier thinkers, adds its own insights and innovations, draws on other streams of thought (with or without crediting the source), and then propounds this complex mixture as in some sense a valid reflection of “reality”—at least within the constraints imposed by the limits of present knowledge. Of course, whether this distinctive amalgam of concepts and practices strikes other people as intriguing, insulting or incomprehensible will depend in turn on their own personal theories and philosophies—just as constructivists would argue! I’ll therefore start with some of the distinctive assumptions that constructivist psychotherapists share, and move from there to the practices they inspire.

1
Constructing a world

Newcomers to postmodern therapies are typically of two types: those who are closet philosophers and share a fascination with theory, and students of a more practical bent who are frustrated with this same tendency toward abstraction! My goal here is to provide just enough orientation to the philosophic frameworks that support constructivist practice to highlight its distinctiveness, taking care to ground some of the loftier concepts in concrete clinical illustrations and methods. Thus, if I sometimes simplify the daunting complexity of postmodern discourse, I hope I can be forgiven. Fortunately, high-level discussions of the theoretical underpinnings of the therapies discussed here are in good supply, and I will point toward some of these throughout the discussion for those readers who want to delve more deeply into the concepts behind the clinical practice.

If there is a unifying theme that links postmodern forms of psychotherapy, it is at the level of their epistemology, or theory of knowledge. Although most therapists who work within this perspective 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 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 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 “things in themselves,” uncontaminated by human knowing.

2
The function of fiction

At the threshold to the twentieth 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 (Vaihinger, 1924). 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 linguistic constructs that help them navigate in the world without contacting it in any simple, direct way. Stated differently, proponents of postmodernism argue that people live in an interpreted world, one organized as much by their individual and collective categories of meaning as by the structure of an “objective” world of external stimuli. In clinical practice, this carries the implication that therapy is more a matter of intervening in meaning than it is a procedure for ameliorating unwanted symptoms or training people in more adequate coping skills, as illustrated in the vignette of Joanne with which this book opened.

3
Personal knowledge

By the 1930s, these and parallel philosophical influences began to find expression in psychology, inspiring a focus on the ways in which people actively construct experience, rather than simply “register” environmental stimuli in a tabula rasa fashion. Among the psychologists to take this avowedly “constructivist” turn were the Swiss developmental psychologist, Jean Piaget, who traced the qualitative transformations through which children schematized the physical and social world, and the British experimental psychologist, Fredric Bartlett, who demonstrated that memories did not simply entail recalling stored events, but instead were constructed in light of present motives through the guidance of mental schemas. Both influences continue to be felt in contemporary research on autobiographical memory, which examines the construction and periodic consolidation of a shifting sense of identity throughout adult life (Fireman, McVay, & Flanagan, 2003; Neisser & Fivush, 1994).

The first person to develop a thoroughgoing theory of psychotherapy that drew upon these philosophic ideas was the American clinical psychologist, George Kelly. Working in the relative isolation of rural Kansas in the 1930s and 1940s, 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 (R. A. Neimeyer, 1999). This prompted Kelly to design efficient psychotherapeutic procedures in which clients were coached to enact carefully constructed fictional identities in their daily lives for a fixed period of time (usually only 2 or 3 weeks), as a way of helping people free themselves from the press of circumstances and experiment with quite different ways of living. Kelly’s fixed-role therapy was therefore the first form of brief therapy, and foreshadowed the use of dramatic and narrative strategies of change incorporated in many contemporary constructivist therapies. Eventually, Kelly (1955/1991) 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 personal construct systems that individuals devised to structure and anticipate the themes of their lives.

A foundational principle of Kelly’s perspective was that each person has a one-of-a-kind operating system—or personal construct system in his terms—that provides an idiosyncratic “map” of the world and one’s place within it. Far from being a regrettable form of idiosyncrasy to be rectified by “right thinking,” the elimination of “cognitive errors” or the clarification of personal “distortions,” the individualism and diversity in our outlooks were for Kelly quintessentially human, the source of both our strengths as a species and our inherent frustrations. That is, the tendency of every single human being to construct a personal theory that imputes different meanings to (partially) shared events contributes to the richness and diversity of relational, social, and cultural life, just as it also poses real puzzles in attempting to “step into” and “indwell” the sometimes subtly or surprisingly alien perspectives of “the other.” An example of the latter arose in my recent telephone contact with a young man in suicidal crisis. After an intensive hour of my attempting to empathize with his pain following his partner’s decision to leave him, and to respond constructively to his self-blame and hopelessness about the ending of the relationship, he paused and said in a hushed tone, “You sound like my best friend” For a moment I felt touched and took heart, hoping I had at least constructed enough of a bridge between us that a follow-up face-to-face session would be helpful. Within a minute, however, I came to understand that for him this phrase meant, “You sound just like my best friend, because you both talk in an emotionally controlled tone about anguishing events that are tearing me apart, and so I can’t trust either of you to really understand or help!” Grasping this idiosyncratic meaning, I backed up and started again, acknowledging my position as a concerned outsider, but offering the active, structuring steps I could to help him through the crisis. Much of the purpose of constructivist assessment methods, as described below, is to help reveal the meanings behind the words, the deeper themes between the lines of the stories clients tell themselves and us about what brings them to therapy.

4
Living on the frontier

In lieu of a fundamental motivational principle to explain why people do the things they do, Kelly proposed that human beings are basically “forms of motion” who don’t need to be pushed and pulled by internal needs or external stimuli in order to “emit behavior.” Instead, he proposed that people are intrinsically active, and our goal as psychologists is to understand not why they act in the first place, but rather in what direction their activity is likely to carry them. For him, the answers were to be found in the network of personal constructs or meanings through which people anticipate the world, and most especially the actions and reactions of other people. This quest to construct and validate a set of reference axes in order to chart action in the social world and to organize one’s own actions and commitments in it was for him never ending; we spend a lifetime looking for recurrent themes in events, using them to predict what will happen next, investing our time, effort, resources, and ultimately our lives in varying degrees in these, encountering the relevant events, suffering the invalidation of our hypotheses or celebrating their usefulness, and actively experimenting with revised or deepened convictions as a result. But for better or worse, we never arrive in a “cognitive Eden” in which we are forever secure, and where the terrain and rules of the game are stable and familiar. Instead, our forward movement toward an uncertain future is like living on the frontier, confronting challenges and innovating solutions as we move forward, pushing back the boundaries of the known world. In fact, accepting the inevitable anxiety of facing continual novelty can be far healthier, Kelly suggested, than falling back repeatedly on old constructs that may be well worn, but stultifying, in essence “choosing” to live with familiar frustrations rather than jettison previous patterns and face the discomforts of reinventing ourselves and our worlds.

Consider the experience of one of my current clients, Melanie, a woman in her early forties whose experience with an “entitled,” materialistic mother and “workaholic” (and alcoholic) father in her childhood and teen years left her yearning for a kind of personal care and attention that was in short supply in her home. Not surprisingly, she found herself adopting the family construct of “bucking up” like her father, displaying an uncomplaining work ethic, against the backdrop of the anticipation that other people would simply be selfish and demanding if she permitted them to draw close to her. Although this role vis-à-vis others served her well in educational and career realms, it was far less successful in her relational world, as her efficiency and task focus made it hard for others to connect with her, except in a businesslike way. Finally, lonely and sad at forty, she allowed herself to “slow down” with Brian, who manifested the sort of casual orientation toward the world of work that she envied and who showed the ability to care for her that she craved. They fell in love, and she soon gave birth to a child. This hoped-for development, however, precipitated an unexpected crisis, as Melanie’s urge to reduce her hours at a demanding job to spend more time with her baby raised the specter of significantly reduced income, with no corresponding eagerness on Brian’s part to seek a more high-powered position for himself in order to compensate. This situation strongly invalidated Melanie’s anticipations of the new family life she was “entitled” to—an idyllic and protected sphere in which she and her child could enjoy the generous time together she never had as a child—and not surprisingly threw her back upon her old and ingrained family construct to navigate the experience: she, like her father, needed to “buck up” once again and silently but resentfully accommodate to the role of primary breadwinner. Motivated to seek therapy by the fear that she was “becoming her father,” she soon recognized that she was caught as much in a construct system that limited her range of alternatives as she was in external exigencies. Our work now consists of understanding the deep purposes served by her current position—including maintaining loyalty to her family of origin, preserving her sense of being “deserving” of something she never had, and more—and reaching for alternative constructs that will help her anticipate and move toward a family life that is something other than the mirror image of her parents.

5
Redefining reality

Although interest in personal construct theory grew slowly in the decades that followed the publication of his work, Kelly was in a sense ahead of his time. Certainly, an emphasis on the role of personal systems of meaning and the fictional construction of identities seemed an odd fit in a field dominated by a concern with unconscious motives on the one hand and the modification of observable behavior on the other. Consequently, it was not until a postmodern Zeitgeist began to work its way into the human sciences and the helping professions some 30–40 years later that significant numbers of psychotherapy theorists began to rediscover Kelly’s insights and extend them in radically new directions.

What is postmodernism (PM), and what is its relevance for clinical practice? As the term suggests, “posties” can best be defined in relation to the traditional intellectual framework that they strive to succeed, undermine, or critique, namely, modernism. Modernism is a broad concept, almost too broad to define with any precision, because it encompasses so many domains of social life. However, as applied to the human sciences, modernism embodies the Enlightenment faith in technological and human progress through accumulation of legitimate knowledge. Throughout its century-long history, psychology has for the most part followed this paradigm through the development of logical, experimental, and statistical methods presumed to yield objective data, providing a secure foundation for theories that were assumed to reflect, with as little distortion as possible, the universal and timeless “realities” of human behavior. “Truth,” in this view, is discovered a bit at a time, whether the “truth” concerned general laws of human behavior or concrete historical determinants of that behavior in the lives of individuals in psychotherapy. At the core of this program was the belief in a knowable world, and with it, a knowable self. In large part, it is this modernist faith in logic, science, and objectivity that underpins traditional cognitive therapies, with their emphasis on critiquing irrational or distorted patterns of thinking that presumably maintain problematic emotions and behaviors. Therapy, in this view, becomes the systematic application of techniques to foster cognitive restructuring so as to promote improved “reality contact,” and with it, better adjustment (R. A. Neimeyer, 1995b).

Dissenting from this traditional view, postmodernism calls into question the very concept of timeless certainty, asserting that all human “realities” are necessarily personal, cultural, and linguistic constructs—although they are no less substantial or important for this reason (Appignanesi & Garratt, 1995). “Truth,” in this view, is actually constituted by individuals and social groups and reflects the dominant social ideologies of the day, however fallible these turn out to be in the hindsight of later generations. For example, cultural norms about the appropriate roles of women or ethnic minorities, laws that prohibit and punish certain behavior, and even psychiatric diagnoses are all historically situated (and changing) social constructions, but this does not mitigate their impact on those subjected to them. Scholars working from a PM perspective therefore seek to reveal the often hidden ways in which reality and power are constructed in the course of social life (Derrida, 1978; Foucault, 1970), and therapists and activists animated by this view attempt to analyze and “deconstruct” these same patterns when they function to limit or constrain the possibilities for a given person or community.

6
Living in language

A corollary of this shift from realism to relativism is that as the apparent power of objective circumstances grows weaker, the power of language, broadly defined to include all symbolic means of labeling reality and regulating human behavior, grows stronger. In this view language is not simply a way of representing reality, it is a way of creating it, literally bringing new social realities into being in the terms that are used, whether in a casual conversation between two friends who agree that a co-worker is a “bitch” or in cultural discourses that define “beauty” in terms that require the relentless pursuit of thinness. Constructivists and their close cousins, the social constructionists (Gergen, 1999), therefore grow interested in how people use language in a way that shapes and delimits how people appraise themselves, others (especially vulnerable others), and life difficulties in ways that are problematic and disempowering. A spirit of “resistance” against the taken-for-granted assumptions of cultural “texts” in the service of personal or social transformation is especially evident in some PM approaches, like the narrative therapies to be discussed later.

Rather than elaborate further at this point on the implications of constructivist epistemology for postmodern practice, we will revisit these themes in the points that follow, considering some of their concrete expressions in the conceptualization of the self, psychopathology, psychological assessment, and therapeutic practice.

7
Deconstructing the self

The concept of “personality” is a two-edged sword. At one level, it serves a useful integrative function, helping explain how the myriad forms and facets of human functioning are organized into a larger and potentially more holistic pattern. Personality, in this sense, is what makes you you, a self both distinguishable from others and recognizable, with meaningful variations and developments, across time. As such, the personality or “self” has played a central role in the history of psychotherapy, serving as an orienting concept for clinical diagnosis, as well as a target for clinical interventions. From Freud’s classic structural formulation of ego functioning (Freud, 1940/1964) to its elaboration by object relations (Kernberg, 1976) and self-theorists (Kohut, 1971), and from early conceptions of the “proprium” (Allport, 1961) to humanistic theories of self-development (Rogers, 1961), various models of personality have provided a foundation for theories of psychotherapy. Even scientifically parsimonious cognitivebehavioral therapies (Beck, 1993) implicitly presume a foundational role for the self in thei...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Introduction
• An illustrative therapy
• Part 1 THE DISTINCTIVE THEORETICAL FEATURES OF CPT
• Part 2 THE DISTINCTIVE PRACTICAL FEATURES OF CPT
• Conclusion
• References