Robert A. Neimeyer

Constructivist psychotherapies

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

1-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.

2-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.

3-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.

4-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.

5-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.


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.

References


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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