Deconstructing Psychotherapy

Ian Parker

• Publisher: SAGE Publications Ltd
• Year: 1999
• Print ISBN: 9780761957133, 9780761957126
• eBook ISBN: 9781446226179
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

`I enjoyed this book, and think that it should find a grateful and attentive readership in the practical field as well as being a central text in academic settings. It will also be well received by those, like myself, for whom the interest is more in deconstructing than psychotherapy? - Dialogues

This book takes the discursive and postmodern turn in psychotherapy a significant step forward and will be of interest to all those working in mental health who are concerned with challenges to oppression and processes of emancipation. It achieves this by: reflecting on the role of psychotherapy in contemporary culture; developing critiques of language in psychotherapy that unravel its claims to personal truth; and the reworking of a place in the transformative therapeutic practice.

Deconstruction is brought to bear on the key conceptual and pragmatic issues that therapists and clinical psychologists face, and the project of therapy is opened up to critical attention and reconstruction. The book provides clear reviews of different viewpoints and will help readers to understand the complex terrain of debates.

PART I

SOURCES AND CONTEXTS FOR THE DECONSTRUCTIVE TURN

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2

TOWARD A NON-REGULATIVE PRAXIS

John Kaye

Can anyone do effective therapy without becoming an instrument of social control, without participating and contributing, often unknowingly, to the construction or the maintenance of a dominant discourse of oppression?

(Gianfranco Cecchin, 1993: ix)

Since its inception, psychotherapy has undergone seemingly dramatic changes in orientation, as have the models derived from these orientations. The most recent of these has occurred over the last decade, largely influenced by the notion that our realities are socially constructed and language-constituted. Language being seen as active and constitutive rather than simply representative, the therapeutic encounter has come to be thought of as a milieu for the creative generation of meaning and therapy itself as a process of semiosis – the forging of new meaning in the context of collaborative discourse (Gergen and Kaye, 1992). Whether this development is a discontinuous one – representing a revolutionary break from the essentialist notions of diagnosing and solving identifiable intrapsychic or intrasystemic problems – is open to question.

A related and equally important issue concerns whether this constructionist development has the potential to contribute to social well-being or whether psychotherapy remains implicitly immured in maintaining the social order, with all its inherent structural inequities. This is particularly pertinent given Hillman and Ventura’s (1992: 3) impassioned contention that ‘We’ve had a hundred years of analysis and people are getting more and more sensitive and the world is getting worse and worse’. While many problems reside in personal hurts or conflicts and others in dysfunctional relationship patterns, and while all are individually experienced, Hillman and Ventura’s words point to the twin dangers of individualizing the problems people experience whilst ignoring their possible sociocultural base.

This consideration must lead us to question whether the enterprise of psychotherapy is largely trapped in a limiting paradigm by virtue of its focus on the intrapsychic causation of problems to the relative exclusion of a concern with the loss of certainty wrought by a changing world or by structurally ingrained inequities – of class, race, gender, economic deprivation and unfavourable living conditions. While it would be somewhat utopian to expect psychotherapy to attempt to find solutions to the injustices of the world, it is surely not too much to ask that therapists engage with issues of social context, together with the role of social inequities in the causation of psychological distress. It would also be remiss for therapists not to take these issues into account in their work, for as Judith Cross (1994) points out, if we ignore the role played by social inequity, we may inadvertently be acting to ask our troubled consultées to adjust to the unjust.

Further, in focusing on the amelioration of individual pain, we run the risk of implying that the sufferer is in some sense either deficient or responsible for the problem – a form of victim-blaming. At the same time, I question whether the language of psychotherapy is necessarily permeated by concepts of deficit as asserted by critics of modernist practices such as Drewery and Winslade (1997) and Gergen (1994). Similarly, I also question the tendency on the part of some critical theorists and those of a constructionist or narrative persuasion to portray those psychotherapies which locate the source of problems within the person as sinister organs of state control, clandestinely hegemonic, colonizing and reproductive of inequitable power relations.

Psychotherapy as a Normalizing Practice

Most psychotherapeutic practices both treat the individual as the locus of pathology (thereby diverting attention from the role played by sociocultural factors in the genesis of psychological distress) and are informed by assumptions of:

1. An underlying cause or basis of pathology.
2. The location of this cause within individuals and their relationships.
3. The diagnosability of the problem.
4. Treatability via a specifically designed set of techniques.

Implicit in these suppositions are the concepts of normality and abnormality, the normatively good or bad and the presumption of a true root cause which can be objectively established, known and remediated. Within this frame, psychotherapy can be seen as an instrumental practice consisting of the treatment of what is judged to be mental disorder and abnormal or dysfunctional behaviour. Therapists working within these parameters seek to bring about a restructuring or reprogramming of behaviour in both individuals and families against some criterion of the normal, the deviant, the well-adjusted, the problematic and non-problematic. From this perspective, therapy is concerned with altering established behaviour patterns and belief systems and with the establishment of alternative, more functional or more socially acceptable patterns.

This model of practice has been questioned on both theoretical and politico-ethical grounds. Firstly, models based on notions of normality or abnormality are potentially pathologizing. As Gergen (1991) has pointed out, the assumption of a problem residing in the individual together with a language of deficit or deficiency can be iatrogenic, leading to what he calls ‘a spiral of infirmity’. The act of helping too is problematic. Most psychotherapies incorporate a theory of function and dysfunction as well as an associated set of activities whereby it is assumed that change can be induced in another by the specially trained and accredited. Therapeutic activity in this frame:

1. Involves the exploration and examination of the consultee’s story within the terms of the therapist’s frame of reference.
2. Attempts to engage the other actively in the process of reinterpreting their narrative within the therapist’s frame, developing new behaviours in accord with it.

As I have written elsewhere (Kaye, 1996), this conceptualization perpetuates the concept of the therapist as having privileged knowledge, a socially accredited expert who can both provide an authoritative true version of a problem and act according to a set of prescribed activities to correct it. In practice this gives rise to a top-down and instrumental therapist-centred activity – one in which the therapist acts instrumentally via dialogue on the ‘client’s’ narrative and behaviour in order to change it rather than working collaboratively together with the ‘client’ toward new solutions which the ‘client’ finds fitting.

The issues thus far discussed raise valid questions about the relative innocence or sociocultural neutrality of therapy. For the issue of what constitutes the normal or the deviant, the functional or dysfunctional is as much a sociocultural variable as a medico-psychological constant. To understand this, one need only trace the changes in DSM categories over the years as these follow changes in socially constructed attitudes and mores. More theoretically, as Ian John (1998: 26) has cogently argued,

psychological knowledge of any description, whether scientifically authorised or not, is itself in the world, or a part of the world. Like the psychological enterprise that revolves around it, it is shaped and constrained by social forces. It bears the marks of the culture from which it has arisen and is at the same time a constituent element of that culture. Neither the knowledge, or the enterprise, are part of a natural order that stands outside of society, and it cannot be assumed that they are necessarily benign, benificent or emancipatory.

Psychotherapy is not informed only by a technico-rational repertoire; it embodies both a moral-ethical discursive formation, prescribing what is socially normative, and a liberal humanist discourse, which instantiates the notion of people as rational autonomous individuals possessing a fixed identity, an essential self vested with agency and a consciousness which is the cause of their beliefs and actions. And just as psychological and psychiatric discourse treat the individual as the locus of pathology, so the moral-ethical and humanistic discursive repertoires make the individual the locus of responsibility. This then does justify queries regarding the role of psychotherapy as a normalizing, socially regulative discipline implicitly caught up in maintaining a given social order as well as queries regarding the consequences for those who seek psychological help.

Frames of Psychotherapy

Whatever the differences between the various models of therapy, all operate within two primary frames. One, a receptive helper frame, privileges the consultee’s narrative and seeks to engage him or her in a process of self-discovery in partnership with an empathic listener who establishes a climate of trust and understanding. The other, a revisioning frame, seeks to ensure participation in the therapeutic process by drawing on the authority vested in the therapist. This approach casts and directs the search for problem solution within the terms of the expert therapist’s conceptual and linguistic frame – establishing a hierarchical relationship which privileges the therapist’s perspective. These two alternate frames represent differences in emphasis – they are not incompatible opposites.

The Receptive Helper Frame

When we experience a problem, most of us, I think, hope that gaining some understanding of the problem or its cause will help resolve it. Under these circumstances too, we might turn to another, hoping to be listened to with understanding and expecting that the other’s perspective might prove helpful in providing us with insight or an explanation that would lead to a solution. Equally importantly, we also experience a need to be heard, understood and treated with understanding, to have our experience of events believed rather than rejected, to have our authorship of experience confirmed rather than disconfirmed.

The provision of a context in which one connects with the experiential world of another and in which that other feels their world of experience to be accepted and acknowledged as meaningful is a central element of the helping interview. Crucial to the provision of an accepting climate is what I have previously called the receptive stance (Kaye, 1993). The receptive stance is characterized by an openness to the other’s experience, a readiness to learn about their world, a canvassing of multiple possible perspectives. It calls for an endeavour to immerse oneself in the other’s story, to understand their point of view, to convey an understanding of how the gloss they put on experience makes sense to the person in the light of the premises themselves. It implies a form of interested inquiry which holds the premises open for exploration. In this way neither participant in the therapeutic dialogue is bound by the consultee’s dominant story or its governing assumptions and presuppositions. Viewed in this manner, the active attempt to understand another’s experience can involve its exploration as well as prompting alternative constructions to emerge.

Many therapists who work within this frame in seeking to understand and explore the problem as presented by their ‘clients’ adopt their frame of reference thereby limiting the range of possible exploration. While it is vital to gain an understanding of the other’s world, change is likely to be limited to the extent that therapists limit their attention solely to the consultee’s frame of reference. A focus on helping people to explore the presenting problem as they see it, on clarifying by means of empathic communication, or even on confronting them with contradictions in their communication, will not necessarily disrupt the behaviour patterns and belief systems which constitute their difficulty, let alone create new horizons of possibility. This is because by adopting the other’s framework as their point of reference, therapists are in danger of being bounded or governed by the other’s view of reality and thereby unwittingly ratifying it.

Again, while it is necessary to understand the other’s perspective, an exclusive focus on understanding the content of their communication encourages a transactional dynamic whereby there is no mutual search for transformative understanding but rather the other determines the nature of the transaction, implicitly defining what is to be discussed, explored, or avoided. People seek confirmation of their beliefs; they try to elicit particular behaviour from others; they tend to avoid exploration of painful or threatening material. If this occurs in therapy, change or growth of understanding is less likely to occur – they are simply continuing to dwell within the belief system or mode of transaction which comprises their problem.

Unfortunately, many counsellors unknowingly collude in this, thereby limiting their potential effectiveness. By endeavouring to be understanding, to reflect understanding and to facilitate exploration of the ‘clients” chosen themes, they restrict themselves to their frame of reference, rather than responding to it from a superordinate framework. As a result, they are prevented from establishing a situation which would enable the other to examine their behaviour from a new perspective, to draw new distinctions which might trigger the evolution of new meanings. Rather, the ‘clients” narrative together with the discursive formations in which it is embedded remain unchallenged and a solution is sought within the story’s terms – thereby circumscribing the teller’s options.

Paradoxically, the activity of helping and launching the other on a journey of self-discovery may itself serve to reinforce the problem experienced by the consultée. The placement of a person in the subject position of patient or client implicitly locates the problem within the person thereby potentially attributing ownership of the problem to him or her. This can encourage interiorization of the problem thereby confirming the presupposition of the self as constituting the problem and the individual as responsible for it (or its amelioration). This individualizing focus set within a discourse of individual responsibility may render both therapist and consultée oblivious to the sociocultural constitution of the difficulty or its location in adverse social conditions. Further, the very practices prescribed by traditional therapies (self-evaluation, self-scrutiny) precisely parallel the practices whereby people are ushered into limiting subject positions.

The Re-visioning Frame and Meta-Communication

In the previous section, I suggested that therapeutic change is likely to be limited if the therapist remains immured within the consultee’s frame of reference. What is required is a superordinate frame, one in terms of which the therapist responds to the other’s narrative, in which the narrative is recontextualized, thereby triggering the development of new meaning and opening up visions of the possible. Specifically, problem dissolution and the evolution of new meanings is most likely to occur in a context which is both receptive and provides responses which:

1. Bring the other to attend to rather than from their beliefs and presuppositions.
2. Have them explore their assumptive world from a new perspective.
3. Prompt the emergence of new ways of construing experience and changed interpersonal attributions.
4. Promote a questioning of the restraints imposed by beliefs which have been taken for granted as true.

For this to occur, three superordinate skills seem necessary:

1. The ability to construct a transactional context which involves the participant(s) in the activity of being different.
2. The ability to focus beyond the ‘client’s’ here and now communication and behaviour by systematically relating it to a higher order framework, thereby reframing it and transforming its meaning.
3. The ability not only to communicate empathic understanding but to communicate about the consultee’s communication, or comment on its connotations.

In this way, the therapist can maintain a receptive stance while also offering statements, questions and frames which might generate new distinctions and meanings – a form of meta-communication.

On the Therapeutic Importance of Meta-communication

Any communication can be treated as something to be understood in its own right. It can also be responded to as a member of some other category of behaviour. A person’s request for a hug, for example, may be responded to as such or classified as an instance of dependency. Similarly, in therapy the helpee’s communication may be responded to with understanding or...

Table of contents

• Cover Page
• Title
• Copyright Page
• Contents
• Notes on the Contributors
• Part I Sources and Contexts for the Deconstructive Turn
• Part II Deconstruction in Practice
• Part III Deconstructing Psychotherapeutic Discourse
• Index