See

discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/300556997

Therapeutic Practice as Social Construction

Chapter · April 2016

READS

106

2 authors:

Kenneth J. Gergen Ottar Ness

Swarthmore College University College of Southeast Norway
270 PUBLICATIONS 7,519 CITATIONS 41 PUBLICATIONS 36 CITATIONS

SEE PROFILE SEE PROFILE

All in-text references underlined in blue are linked to publications on ResearchGate, Available from: Kenneth J. Gergen
letting you access and read them immediately. Retrieved on: 06 May 2016
From: M. O’Reilly, and J. Lester (Eds.) Handbook of adult mental health. London: Palgrave,
2016

CHAPTER 26: THERAPEUTIC PRACTICE AS SOCIAL CONSTRUCTION

Kenneth J. Gergen (Swarthmore College, USA)

&

Ottar Ness (Buskerud and Vestfold University College, Norway)

Chapter contents
1. Introduction.
2. Social Construction and Therapeutic Orientation.
3. Social Construction and Therapeutic Practice.
4. References.

If I were to wish for anything, I should not wish for wealth and power, but for the passionate

sense of the potential...what wine is so sparkling, so fragrant, so intoxicating, as possibility!

Soren Kierkegaard

Introduction

Across a significant spectrum of the therapeutic profession, we find a gradual but ever

intensifying convergence in conceptions of the therapeutic process. At the heart of this

convergence lies the human activity of generating meaning. First and foremost we find the

therapeutic relationship one in which human meaning is not only focal, but pivotal to the

process of therapeutic change. The significant preparation for the contemporary movement

has come from many sources. Humanistic/phenomenological/hermeneutic psychologists have

long argued for the centrality of individual meaning to the therapeutic process; the pioneering

work of George Kelly (1955) and the ensuing dialogues on constructivism also placed

1
individual construal at the centre of the therapeutic relationship. The emergence of object

relations theory in psychoanalytic circles further stressed the interdependence of meanings

within family relations and between the therapist and client (Mitchell, 1988); similarly,

Gestalt therapists shifted their focus toward the creation of meaning within the relational

process. The work of the Palo Alto group – eventuating in Watzlawick, Jackson and Beavin’s

1967 classic, Pragmatics of human communication -extended this emphasis on interdependent

meanings within families; Milan systemic therapists (Boscolo, Ceccin, Hoffman & Penn,

1987; Campbell, 2003) carried this orientation forward into a range of new and challenging

practices. More pointedly, however, a concern with the social as opposed to the individual

origins of meaning making became increasingly focal. This concern, often referred to as

social constructionist, is realized in a wide range of therapeutic practices, including narrative

therapy, solution focused therapy, gestalt therapy, and dialogic therapy. This work is

extended, as well, into such arenas of social work (Witkin, 2011), pastoral counselling

(Liegeois, Ramsleigh, Corveleyn & Burggraeve, 2012), bereavement (Hedtke, 2012), youth

ministry (McCoy, 2013), and mindfulness practices (McCowan, 2013).

As these early dialogues on social meaning have unfolded and interacted, the therapeutic

profession has become increasingly cognizant of social constructionist interchange within the

broader intellectual community – in anthropology, communication, history of science,

sociology, philosophy, women’s studies, cultural studies, literary theory, and more. Within

this broader community, constructionist ideas have functioned at two levels. First they have

functioned as a general theory of knowledge. At this level it is proposed that all accounts of

the real, the rational, and the good find their origins in social communities. Thus, all

candidates for truth – whether in science, religion, or everyday life are the outcomes of

culturally and historically situated social interchange. At this meta-level, constructionism

2
functions as a non-foundational foundation. Its value lies not in its truth (which claims are

themselves constructed) but in its pragmatic value for humankind. Secondly, constructionist

ideas also function as a vocabulary of practice, that is, a set of ideas that can be put into use –

professionally, personally, and otherwise. At this level they have often been contrasted with

constructivist conceptions (Maturana, 2008; Von Glasersfeld, 1955 ) which trace the origins

of meaning (and thus to presumptions about reality) to individual minds. While

constructionists have found constructivism conceptually and ideologically flawed, there is no

attempt to destroy such a position. The question here is not whether constructivism is true, but

how useful are its suppositions for various purposes. Here practitioners from various fields

have relied on constructionist ideas not only for social critique (with liberatory goals), but to

furnish insights and inspiration in developing new forms of research, along with dialogic and

collaborative practices in organizational change, education, conflict resolution, and more.

To be sure, social constructionist ideas have provoked a great deal of controversy both within

the therapeutic profession (Efran et al, 2014; Held, 1996)., and without (Parker, 1998;

Hacking, 2000). For cognitively oriented constructivists it has also meant a shift toward a

social constructivism (Neimeyer & Raskin, 2001). More productively, however, a new range

of significant questions has emerged: what new therapeutic orientations may be invited by a

shift toward a social constructionist account of meaning; in what important ways does a

constructionist shift disrupt existing therapeutic traditions; what forms of therapeutic practice

are invited; what are the implications for diagnostic practices and mental health policies; what

may be lost in this transformation and what is gained? Thus, in what follows we shall first

attempt to extricate a number of pivotal assumptions playing through the emerging dialogues

on social construction, to sharpen them through comparison with existing traditions, and to

treat some of the central problems that they raise. This treatment will set the stage for an

3
inquiry into the kinds of practices that are invited by a social constructionist oriented

orientation to therapy. The attempt in these accounts is not to generate a new foundation for

therapy; such a goal would be antithetical to social constructionist dialogues. Rather, the hope

is that the present discussion can contribute to generative conversation, a maturing of

sensibilities, and the emergence of new practices.

Social Construction and Therapeutic Orientation

We wish first to focus on four transitions in understanding that follow from a conception of

therapy as the relational construction of meaning. While these transitions have a variety of

practical implications, our focus here is not centred so much on specific techniques as the

kind of therapist sensitivities that are invited. What do these shifts in assumption invite in

terms of our thinking about therapeutic options? Consider the following:

From Foundations to Flexibility

Traditional orientations toward therapy are derived from what are commonly viewed as

rational foundations of knowledge. These foundations are typically lodged within what is

narrowly defined as an empiricist conception of knowledge. As this tradition has played out in

the social sciences, most professionals have come to hold that theories of human behaviour

should be grounded in observation. With continued and rigorous observation we should

approach a true and objective understanding of both normal and abnormal behaviour. Further,

from this standpoint, continued research should reveal which of a variety of therapeutic

practices is most effective for treating various forms of abnormality. There may be many

candidates for truth about persons, dysfunctions, and cure, but empirical research should, on

the traditional account, ultimately enable us to winnow the many to a few – and ultimately to

perhaps one.

4
For the social constructionist theories of human action are not built up or derived from

observation, but rather grow from our collective attempts to interpret the world. In this sense,

it is the conventions of intelligibility shared within one’s professional enclave that will

determine how we interpret the observational world. Thus, a psychodynamic therapist will

find evidence for repressed desires, while a cognitive behavioural therapist will locate

problems in the individual’s mode of information processing, and a family systems therapist

will be drawn to the realities of family communication patterns. Because theories serve to

construct the world in their terms, there is no means of empirically testing between them.

Each “test” would inevitably construct the field of relevant facts in its terms and thus serve to

privilege some theoretical standpoint as opposed to another. Outcome research is subject to

the same problem; a positive outcome from one therapeutic standpoint (e.g., symptom

reduction, expressed feelings of well-being) may signify a regression or problem exacerbation

for others. From certain standpoints even suicide may be counted as a positive outcome.

Based on this line of reasoning constructionism invites an abandonment of the search for

foundations – a single view of knowledge or human functioning that prevails over all others.

The constructionist dialogues encourage us to relinquish the longstanding competition among

schools of therapy, along with the related conceptions of fixed diagnostics, “best practices” of

therapy, and outcome comparison (Lock & Strong, 2012; McNamee, 2004; McNamee &

Gergen, 1992). Rather, if we view the various therapeutic schools as communities of

meaning, then each school possesses transformational potential. Each offers an opening to a

form of life.

5
The major implication of this line of reasoning for therapeutic practice is clear: the therapist is

invited to move across the domain of therapeutic intelligibilities and practices and to employ

whatever may be serviceable in the immediate therapeutic context. In this sense, there is no

“social constructionist method” of therapy. To formalize any method – to canonize its

principles – is to freeze cultural meaning. It is to presume that effective processes of forging

meaning in the present will remain so across time, circumstance, and context of interpretation.

This is also to say that the common critique within the therapeutic community – that the

multiple and ever shifting field of theory and practice reveals a state of confusion and a lack

of real knowledge – is ill founded. This very richness of intelligibility and the capacity of the

therapeutic profession continuously to refashion understanding represent perhaps its most

significant strengths.

Yet, the implications of this position are more radical than that of favouring of theoretical and

practical eclecticism. Within the empiricist tradition the professional account of the person

and the therapeutic process was privileged over that of the common culture. Whereas the

quotidian understandings of the culture were said to be fraught with bias, misunderstanding,

and superstition, the discourse of the profession furnished more comprehensive and accurate

understanding. For the constructionist the criterion of “more accurate or objective

understanding” is removed; all forms of understanding are culturally embedded constructions

(Gergen, 2009). Effective therapy may – and typically will – require the use of many speech

genres, including those of the culture at large. This is to say that for purposes of therapeutic

practice, the door is opened to the full range of cultural meanings. To be sure, this may

include all existing forms of therapy – from psychoanalytic, behaviour modification,

cognitive, Rogerian, and more.

6
At the same time, we must be prepared to radically expand the arena of usable meanings. For

example, there is strong support here for those wishing to include spiritual discourse within

the therapeutic process (Lines, 2006). For much of the population such discourse speaks in a

powerful way; to neglect its significance is therapeutically myopic. The skilled therapist in a

constructionist mode might be as much at home speaking the languages of romance, the

street, the locker room, or the nightclub as mastering the nuances of Lacanian analytics. Each

new intelligibility enriches the range and flexibility of the relational moment. This does not

mean that professional theories are without special merit. Professionally developed theories

are especially significant in their capacity to offer alternatives not easily located within the

common culture. Professional languages also enable therapists to engage in communal

deliberations – to speak meaningfully with each other and thus to coordinate their efforts

more effectively. And, such discourse further enables the therapeutic profession to reflect

critically on the common intelligibilities of the culture – which reflection cannot be done from

within these intelligibilities themselves.

From Essentialism to Consciousness of Construction

As suggested the modernist therapeutic tradition is invested in truth. Thus, therapy is typically

oriented toward locating “the real problem,” the “causes of the difficulty,” “the forces at

work,” “the determining structures,” and the like, and assessing the effects of contrasting

therapeutic practices on outcomes. For the constructionist there are no problems, causes,

forces, structures and so on that do not derive their status as such from communally based

interpretations. This is not to propose that “nothing exists,” or that “we can never know

reality,” – common misunderstandings of constructionism – but rather that when we attempt

to articulate what exists, to place it into language, we enter the world of socially generated

meanings. It may be more helpful, then, to say that constructionism operates against the

7
tendency to essentialize the discourse, that is, to treat the words as if they were pictures, maps

or replicas of essences that exist independent of we who interpret our existence in this way.

Traditional therapy has more or less presumed a picture theory of language. Thus, useful

language should provide an accurate picture of an independent world. It is only under these

assumptions that such terms as “delusion,” “distortion,” “misperception,” and

“misattribution,” are intelligible. Constructionism, in contrast, invites us to see such terms in a

horizontal rather than a vertical plane, that is, as indicators of an alternative way of

constructing the world (one among many) as opposed to the necessary or superior way. To

accuse a person of being deluded is primarily to say that he or she does not share your

interpretive conventions. As Berg and de Shazer (1993) thus propose, “Meanings arrived at in

a therapeutic conversation are developed through a process more like negotiation than the

development of understanding or an uncovering of what is ‘really’ going on” (p. 7).

Understanding of therapy as a venture in constructing worlds is now broadly shared.

This emphasis on constructed realities must be accompanied by an important caveat.

Constructionism does recognize the significance of truth in context. Within any community

there will be tendencies toward essentializing the commonly shared modes of discourse –

treating the language as a “map of the real” – and this essentialization is of inestimable

importance in sustaining the community’s traditions. It is thus important for the

constructionist-oriented therapist to participate in the reality creating conventions (i.e., “He is

my husband,” “I am depressed.”), while simultaneously realizing the contingent character of

the conventions.

From Expertise to Collaboration

8
As proposed, there is no singular set of practices that follow or can be derived from a

constructionist view. For example, there is nothing about constructionism that would

necessarily be against the therapist’s “taking an authoritative stand” in a therapeutic

relationship; strong and directive opinions may sometimes be useful. However, if we play out

the implications of constructionism as a theory of human action, new doors are opened to

practice. In particular, constructionist theory invites the therapist to consider alternatives to

the traditional position of authority, and particularly to explore a collaborative orientation to

the client. The shift in style is no small undertaking. As Hoffman (1993) writes:

“the change from a hierarchical to a collaborative style...is a radical step. It calls into

question the top-down structuring of this quasi-medical field called mental health and

flies in the face of centuries of traditional western practice...To challenge these

elements is to challenge the whole citadel.” (p. 4)

The shift to a collaborative orientation has early roots in the work of Goolishian and

Anderson (1997) on “collaborative language systems” approach, proposed a collaborative

partnership with the client in which the therapist enters with a stance of ”not knowing.” Not-

knowing refers to:

“an attitude and belief that a therapist does not have access to privileged information,

can never fully understand another person, always needs to be in a state of being

informed by the other, and always needs to learn more about what has been said or

may not have been said... Interpretation is always a dialogue between therapist and

client and not the result of predetermined theoretical narratives essential to a

therapist’s meaning, expertise, experience or therapy model.” (Anderson, 1997, p.

134)

This is not to say that the therapist does not bring uniquely valuable skills to the relationship.

It is to say, however, that such skills are not derived from a mastery of descriptive and

9
explanatory accounts of therapy. They are primarily skills in knowing how as opposed to

knowing that – of moving fluidly in relationship, of collaborating in the mutual generation of

new futures. A collaborative dialogue in therapy involves more than expert exchanges of

information from therapist to client. Collaboration in therapy is a dialogic process requiring a

delicate and ongoing negotiation of client and counsellor preferences, meanings, and

conversational process (Strong, et al., 2011). A specific emphasis on therapy as collaboration

is now shared by wide-ranging therapists (Anderson & Gerhart, 2006; Håkansson, 2009;

Ness, Borg, Semb & Karlsson, 2014; Paré, 2013; Strong, Sutherland & Ness, 2011).

Exemplary, for example, is the work of Asen and colleagues (2010) bringing multiple

families together to share their resources.

From Value Neutrality to Value Relevance

From the empiricist standpoint therapy is not a forum for political, ideological, or ethical

advocacy. The good therapist, like the good medical doctor, should engage in sensitive

observation and careful thought, unbiased by his/her particular value biases. Critiques of the

assumption of value neutrality have long been extant. The works of Szasz (1970), Laing

(1967), and participants in the critical psychiatry movement have made us acutely conscious

of the ways in which well-intentioned therapists can contribute to forces of oppression.

Spurred by Foucault’s (1979) critique of the “disciplining” effects of therapeutic practices,

many recent analysts have focused on ways in which various therapies and diagnostic

categories contribute to sexism, racism, heterosexism, individualism, class oppression, and

other divisive biases. From a constructionist standpoint even a posture of non-engagement or

“neutrality” is viewed as ethical and political in its consequences. Whether mindful or not,

whether for good or ill, therapeutic work is necessarily a form of social/political activism.

Any action within a society is simultaneously creating its future.

10
Many therapists, cognizant of the relationship between therapeutic constructions and societal

values, have begun to explore the implications of ethically and politically committed therapy.

Rather than avoiding value considerations, socio-political aims become central. We have,

then, the development of therapies that are specifically committed, for example, to

challenging the dominant order (see for example, White & Epston, 1990) and pursuing

feminist, gay, socialist and other political ends. Feminist therapists, for example, frequently

focus on female oppression as a fundamental therapeutic theme, or deconstruct gender

categories to provide clients an expanded set of options. Social therapy carries with it a vision

of equalitarian society (Holzman & Mendez, 2003). With the expanding power of identity

politics there is every reason to anticipate an expansion in such investments.

Social Construction and Therapeutic Practice

As we have seen, social constructionist dialogues favour four major movements in therapeutic

orientation – movements toward flexibility, consciousness of construction, collaboration, and

value relevant practice. However, such dialogues also invite a new range of practices. Many

of these practices are now well entrenched in certain circles; others are under development. In

each case it is important to see their relationship with constructionist thinking. We will focus

here on five major shifts in practice:

From Mind to Discourse

Most traditional therapy is focally concerned with individual mental states. From the

psychoanalytic emphasis on psychodynamics, Rogerian concerns with self-regard, to

contemporary cognitive behavioural therapy, it is the central task of the therapist to explore,

understand, and ultimately bring about transformation in individual minds. Even group

psychotherapy has retained a strong investment in psychodynamic principles. As outlined in

11
the preceding chapter, interest in therapeutic communication did begin to occupy increasing

attention over the years, and within recent decades converging interests in family systems,

communication pragmatics, and second order cybernetics – among the more visible – have

brought issues of language into major focus. Yet, as also proposed in the preceding, the

constructionist dialogues extend these discussions in significant ways. It is largely through the

discursive relationship that realities, rationalities, values, desires come into being, flourish or

expire.

This shift to discourse is perhaps the most widely apparent aspect of therapy in a

constructionist frame, and has given rise to a broad range of therapeutic innovations. As

Sluzki (1992) has put it, therapy may be understood as a process of “discourse

transformation.” If meaning is generated within linguistic processes, then it is to these

processes that attention is drawn (Lock & Strong, 2012). The vast share of innovative work

has been congenial with the groundswell of social science interest in narrative, or essentially

the storied construction of self and world (Bamberg, 2007; Randall, 2014; Sarbin, 1988). For

many therapists Donald Spence’s (1982) “Narrative Truth and Historical Truth” represented a

critical turning point. Here was a practicing therapist of long experience who no longer that

historical truth could be captured in the patient’s accounts of his/her early life, and explored

the positive uses of the narrative truths developed in therapy.

Yet, perhaps the most prominent expression is found in what McLeod (1998) calls the

“postmodern narrative movement.” As developed by therapists such as White and Epston

(1991), and enriched and expanded in numerous ways over the years (Epston & Lobovits,

1997; Freedman & Combs, 1996; Freedman; Madigan, 2011) the prevailing concern is with

the ways in which language constructs self and world, and the implications of these

constructions for client well-being. The radical implication of such work is that life events do

12
not determine one’s forms of understandings, but rather, the linguistic conventions at our

disposal determine what counts as a life event and how it is to be evaluated. It is much the

same concern with the force of language in constructing client realities that has sparked the

therapeutic use of metaphor (Combs & Freedman, 1990), and the development of client

writing practices as therapeutic tools. As this emphasis on language has expanded, many have

come to see constructionist-oriented therapies specifically as discursive therapies (Lock &

Strong, 2012; Strong & Paré, 2004).

It should be pointed out that there is a tendency among the emerging therapies to adopt a

limited narrow definition of discourse – principally as spoken or written language. Given our

traditions this is a comfortable starting point, enriched as well by an expansive literature on

semiotics, literary theory, rhetoric, and linguistics. At the same time such a preoccupation is

reductionistic. First, it reduces discourse to the utterances (or writing) of the single individual.

Yet, if meaning is the by-product of relationship, then such a focus is blind to the relational

process from which any particular utterance derives its meaning. In effect, words mean

nothing in themselves, and it is only by attending to the flow of interchange that we can

appreciate the origins, sustenance and decay of meaning. Further, the emphasis on words

strips discourse of all else about the person (and situation) that is essential to generate

intelligibility. One speaks not only with words, but with facial expressions, gestures, posture,

dress and so on. Ultimately it is important to add bodily and material dimensions to the

concern with communication.

From Self to Relationship

The traditional therapeutic emphasis on mental states is in close harmony with the western

belief in the individual actor as the atom of the social world. For at least 300 years we have

13
moved progressively toward what is now simply a taken for granted fact: the individual's

public actions are by-products of internal states of mind (e.g., thoughts, emotions, motives,

choice, desire, and memory). Shouldn’t therapy, then, be primarily focused on the internal

world of the individual? And yet, within recent years we have also become increasingly

conscious of the biases built into this view. For example, on the traditional view, relationships

are secondary or artificial contrivances, constructed from the raw materials of independent

selves. In an attempt to correct for this individualist bias, movements in group and family

therapy have offered a range of alternative practices built around such concepts as group

dynamics, family structure, and psychological interdependence.

With the constructionist shift from mind to discourse the terrain shifts significantly toward the

primacy of relationship. As Wittgenstein (1953) argued, there can be no private language; if

you created your own private language you could not communicate. In effect, language is a

fundamentally a relational phenomenon – much like a handshake or a tango, it cannot be

performed alone. Or in Shotter's (1993, 2008) terms, meaning is not created by individuals

acting alone, but in joint-action. In effect, meaning is not located within the mind of

individual actors, but is a continuously emerging achievement of relational process. It is in

this context that we appreciate more fully the earlier emphasis on co-construction. It is within

the relational matrix of therapist-and-client that meaning evolves.

Yet, while many of the practices included in this analysis shares this premise, the emphasis on

relationship (as opposed to individual mind) expands in many directions. It is useful here to

think of concentric circles of relationship, starting first with the therapist-client, and

expanding then to the client's relationship with immediate family, intimates, friends and the

like. At a first level of expansion, some therapies press backward in time to consider

14
relationships in the distant past. As Mary Gergen (1999) has proposed, we carry with us a

cadre of "social ghosts," As one means of tapping into significant relationships, Penn (2012)

and others have had clients to write letters to a lost loved one. Karl Tomm and his colleagues

(2014) propose a means of investigating and treating a variety of patterns common in families

and other groups. Further expanding the circle, still other therapies take into account the

broader community – the workplace, church and the like. In Sweden, Håkansson (2009) and

her colleagues enable diagnosed schizophrenics to live with farm families, with remarkable

results. And finally, other therapies are vitally concerned with the relationship of the

individual to the broad social context – to institutions of power, cultural traditions of

suppression, and the like. The "social therapy" of Holzman and Mendez (2003) for example,

attempts to link individual problems with the broad social conditions of society – race

relations, employment opportunities, and community action. In the same vein, Freeman,

Epston and Lobovits (1997) write, “Since problem-saturated stories are nested in social,

cultural, economic and gender assumptions about roles and behaviour, we inquire about these

factors and strive to be aware of how they are affecting different family members” (p. 51).

From Singularity to Polyvocality

Traditional therapies have been enchanted by metaphors of the singular and unified. By this

we mean, first of all, that the therapeutic profession has gathered round the dream of the

single best therapy. We continuously carry out evaluation studies in the hopes of finding

which form of therapy is the most effective. Further, we have convinced ourselves that the

ideal person is coherent in mind and action. We have not been content with internal tensions,

splits, and multiplicities of self (consider, for example, the "diseases" of multiple personality

disorder and schizophrenia).

15
With the emergence of constructionist consciousness, the traditional romance with unity is

placed in question. The argument for multiple constructions of the real – each legitimate

within a particular interpretive community – renders the concept of the "single, coherent

truth" both parochial and oppressive. Further, with increasing consciousness of the multiple

relationships in which people are embedded – each constructing one's identity in a different

way – the ideal of a unified self seems increasingly unappealing. Indeed, in a cultural context

of rapidly expanding networks of relationships, the call to singularity also seems counter-

adaptive (Gergen, 2009). To thrive under these conditions of rapid change may require

something akin to a protean personality. It is within this intellectual and cultural context that a

new range of therapeutic practices has been nurtured or refashioned.

In this context, many therapists within a constructionist frame press toward multiplicity of

client realities. As Weingarten (1998) writes: "a postmodern narrative therapist is generally

uninterested in conversation that tries to ferret out the causes of problems. Instead, she is

extremely interested in conversations that generate many possible ways to move forward once

a problem has arisen" (p. 114). It is here that the work of Tom Andersen (1991) and his

colleagues on reflecting processes provided an important breakthrough. Using multiple

observers of a family, for example, each free to reflect on their interaction in his/her own way,

family members are exposed to a range of possible interpretations. Further, as the family is

invited to comment on these interpretations, they are set free to consider all options –

including those which they develop as alternatives. There is no attempt here to determine the

"true nature of the problem," but rather to open multiple paths of interpretation, and thus paths

to alternative futures.

16
In addition to practices of interpretive enrichment, many other therapists have specifically

focused on self-multiplicity. Most pointedly, for example, Karl Tomm (1999) has developed a

process of "internalized other interviewing," during which his questions draw out the voice of

another person within the client. For example, if a client is uncontrollably angry at another

person, the client might be asked to imagine him or herself in the other's shoes, and speak

from the "position of the other." Can the client find the voice of the other within him or

herself; to do so is to bring the anger under control. In a more general frame, Penn and

Frankfurt (1994) find that many of their clients enter therapy with "constricting monologues."

As therapists, they encourage the development of "narrative multiplicity." They first introduce

the possibility of alternative voices – for example positive, optimistic or confident – into the

conversations with clients. Then, the client is encouraged to write letters to persons living or

dead, dialogues, notes to themselves, journal entries, poetry – in a manner that evokes new

voices within themselves. Similarly, Riikonen and Smith (1997) focused on the ways in

which culturally dominant discourses constrict individual action. Classic are cases of physical

or sexual abuse, where victims too quickly embrace conventional views in which they are

defined as unworthy or deserving the abuse. In such situations the therapists ask such

questions as: "Where do you think these oppressive descriptions come from? Which other

types of descriptions/voices in you have been silenced? Have you been able to listen to other

ideas? What might it mean if you were able to listen more to those different ideas?" (p. 123).

As Hermans and Hermans-Konopka (2010) further detail, the new voices set in motion

internal dialogues that have significant potential for therapeutic change. The concern with

internal dialogue continues to demand widespread attention (Bertaux, Goncalves, & Raggatt,

2012).

17
A contrasting approach to polyvocality comes from therapists seeking means of bringing

multiple voices into the deliberations on “the problem” and “how to go on.” Specifically

attempting to generate an alternative to the monologic orientation of traditional psychiatry is

the work of Seikkula and his colleagues (Seikkula & Arnkil, 2006) on Open Dialogue. Open

dialogue may enlist the voices of multiple stakeholders, and emphasizes an empathic listening

to others’ experiences, views, meanings, and interpretations. Through these means a dialogic

“team” is formed. The e results in terms of reducing dependence on psychopharmacology

and hospitalization have been substantial developed by (Seikkula et al., 2006).

From Problems to Prospects

As widely recognized, traditional therapy is based on a medical model of disease and cure.

Patients (clients) confront problems – typically indexed as pathologies, adjustment

difficulties, dysfunctional relationships, etc. – and it is the task of the therapist to treat the

problem in such a way that it is alleviated or removed ("cured"). It is the assumption of "the

problem" that underwrites the process of diagnosis and indeed, fuels the development of

diagnostic criteria (e.g., the DSMV). From a constructionist standpoint, however, this entire

array of interlocking presumptions and practices engages in the realist fallacy of presuming

that "problems" (diseases) exist independent of our forms of interpretation. For the

constructionist the term "problem" is a discursive integer, and may (or may not) be used to

index any condition or state of affairs. It is not the "problems of the world" that determine our

ways of talking, for the constructionist, but it is through our discursive conventions that we

determine something to be a problem. Again, this is not to abandon the term or its

conventional usages, but rather, to give us pause to consider the consequences. For, as many

reason, "problem talk" often reifies a world of anguish; to speak of one's incapacities, an

irredeemable other, or a dysfunctional family is to create a world in which one's actions are

18
limited, and very often in which these very limitations sustain the patterns termed

problematic.

With these arguments at hand, therapists have developed a new range of practices that attempt

to avoid the reification of problems, and shift attention to a discourse of positive prospects. As

Riikonen and Smith (1997) put it, "We have been accustomed to talk about analysing

problems as a prerequisite of solving, dissolving or deconstructing them. It seems in most

cases more useful to talk about actions, experiences and thoughts which can help to make

things better." (p. 25) Most visible in this respect is the work of solution-focused therapies (de

Shazer, 1994; O’Hanlon & Weiner-Davis, 1989). The "miracle question" is essentially an

invitation to a new domain of dialogue in which the creation of future realities takes

precedence over the reification of past problems.

From Insight to Action

Traditional therapies, linked to the presumption of individual psychological deficit, have also

focused on the individual psyche as the site of therapeutic change. Whether, for example, in

terms of the transference of psychological energies, catharsis, self-understanding, self-

acceptance, re-construal, or cognitive change, most therapeutic practices have been built

around the assumption that successful therapy depends primarily on a change in the mind of

the individual. Further, it is typically supposed, this change can be accomplished within the

therapeutic relationship. The concept of the "therapeutic breakthrough" epitomizes this point

of view; once change is accomplished in the therapeutic chamber there is hope that the

individual will depart emancipated from the preceding burden with which he/she entered

therapy. For discussion purposes let us simply use the phrase individual insight to index this

class of practices.

19
Yet, as we shift the emphasis away from individual minds and to discursive relations among

individuals, we find the traditional array of practices delimited if not short-sighted. From the

constructionist standpoint, the process of generating meaning is continuous, and its form and

content likely to shift from one relationship to the next. The individual harbours multiple

discursive capacities, and there is no strong reason to anticipate that the meanings generated

within the therapeutic relationship will be carried over into outside relationships. The

dramatic insight shared between therapist and client is essentially their achievement, a

conversational moment that derives its significance from the preceding interchange and

cannot easily be lifted out and placed within another conversation remote in time and place.

There is a further and more pro-active shift in therapeutic implications derived from

constructionist dialogues. When we locate the source of meaning within dialogic process, we

are essentially viewing the meaning-making process as social activity. Meaning, then, is not

originated within the mind and stored there for future use, but rather is created in action and

regenerated (or not) within subsequent processes of coordination. Following Wittgenstein

(1953) we might say that meaning is born of social use. Or, in de Shazer's (1994) terms:

"Rather than looking behind and beneath the language that clients and therapists use,

I think the language they use is all we have to go on...Contrary to the common sense

view, change is seen to happen within language: What we talk about and how we talk

about it makes a different..." (p. 10)

In this context the primary questions to be asked of therapeutic co-construction are: (1)

whether a particular form of discourse is actionable outside the therapeutic relationship, and

(2) whether the pragmatic consequences of this discourse are desirable. To illustrate, in a

Jungian practice one might acquire an entirely specialized vocabulary of individuation,

20
mandalas, the shadow, and so on. Yet, while this vocabulary will enable a fully harmonious

relationship to develop within the therapeutic relationship, it is not easily transportable

outside. The vocabulary can accomplish little in the way of conversational work. Or, in primal

scream therapy one may acquire the capacity for dramatic expressions of rage and anguish.

And, while these expressions can produce significant effects in the marketplace of social life,

the consequences are not likely to be helpful to the client.

These twin criteria – actionability and pragmatic outcome – have been slow to surface in the

constructionist literature and practices. In some degree this relative unconcern is based on the

view that therapeutic conversation (along with internal dialogue) yields results in the external

world of relationships. Yet, this assumption is largely a promissory note. Much needed are

practices specifically dedicated to forging this link. There are good examples extant. For

example, White (2011) has generated a variety of authenticating practices for giving life to

newly emerging narratives. They may have celebrations, give prizes with significant people in

attendance, or generate "news releases" in which the individual's arrival at a new status in

announced to various significant others. White recruits what he terms "The Club of Your

Life,” which might include anyone, living or dead, actual or imaginary. Epston and his

colleagues (Madigan & Epston, 1995) help clients sharing eating disorders to develop

politically oriented support groups. Social therapists (Holzman & Mendez, 2003) encourage

and facilitate social activity as a critical component of practice. The emphasis on practical

action also helps us to appreciate certain features of some traditional practices. For example,

both group and family therapy practices seem favoured over individual therapy, as in such

contexts one's discourse enters directly into a public arena, and its pragmatic consequences

made more manifest. Further we find new purchase on role-playing therapies. If properly

directed, the client gains skills in forms of social doing; otherwise alien forms of expression

21
are incorporated into one's vocabulary of relationship. Buddhist practices of mindfulness and

meditation are welcome additions to the vocabulary of action (Kabat- Zinn, 2005; Kwee,

2013). In our view, the greatest opportunities for future development lie in this arena of

pragmatic consequences of therapeutic conversation.

Clinical practice highlights

1. From a focus on mind to the development of meaning in relationships.
2. From a focus on the individual to the relational network.
3. From a singular truth to multiple perspectives.
4. From exploring the individual’s problems to promising potentials.
5. From developing insights to fostering useful skills.

References

Andersen, T. (1991). The reflecting team: Dialogues and dialogues about the dialogues. New

York: Norton.

Anderson, H. (1997). Conversation, language and possibilities. A postmodern approach to

psychotherapy. New York: Basic Books.

Anderson, H., & Gerhart, D. (Eds.) (2006). Collaborative therapy: Relationships and

conversations that make a difference. New York: Routledge.

Asen, E. & Scholz, M. (2010) Multi-family Therapy: Concepts and Techniques. London:

Routledge.

Bertau, M-C., Goncalves, M.M., & Ragatt, PT.F. (Eds.) (2012) Dialogic formations:

Investigations into the origins and development of the dialogical self. Charlotte, NC:

Information Age.

Asen, E., & Scholz, M. (2010). Multi-family Therapy: Concepts and Techniques. London:

Routledge.

Bamberg, M. (Ed.) (2007). Narrative – State of the Art. Philadelphia: John Benjamins.

22
Berg, I.K., & De Shazer, S. (1993). Making numbers talk: Language in therapy. In S.

Friedman (Ed.) The new language of change: Constructive collaboration in

psychotherapy. (pp. 5-24). New York: Guilford Press.

Boscolo, L., Ceccin, G., Hoffman, & Penn, P. (1987). Milan Systemic Family Therapy:

Conversations in theory and practice. New York, NY: Basic Books.

Campbell, D. (2003). The mutiny and the bounty: The place of Milan ideas today. Australian

and New Zealand Journal of Family Therapy, 24, 15-25.

Combs, G., & Freedman, J. (1990). Symbol, story, and ceremony: using metaphor in

individual and family therapy. New York: W.W. Norton.

De Shazer, S. (1994). Words were originally magic. New York: W.W. Norton.

Efran, J.F , McNamee, S., Warren, B., & Raskin, J.D. (2014). Personal construct psychology,

radical constructivism, and social constructionism: A dialogue, Journal of

Constructivist Psychology, 27, 1-13.

Freedman, J., & Combs, G. (1996). Narrative therapy: The social construction of preferred

realities. New York, NY: Norton.

Freedman, J., Epston D., & Lobovits, D. (1997). Playful approaches to serious problems:

Narrative therapy with children and their families. New York: W.W. Norton.

Foucault, M. (1979). Discipline and punish: The birth of the prison. (Trans. by A. Sheridan).

New York: Vintage Books.

Gergen, K. J. (2001). The saturated self. (2nd. ed.). New York: Perseus.

Gergen, K. J. (2009). Relational being: Beyond self and community. New York: Oxford

University Press

Gergen, M. (1999). Feminist reconstructions in psychology: Narrative, gender and

performance. Thousand Oaks, CA: Sage.

23
Goolishian, H., & Anderson, H. (1987). Language systems and therapy: an evolving idea.

Psychotherapy, 24, 529-538.

Hacking, I. (2000). The Social Construction of What. Cambridge, MA: Harvard

University Press.

Hedtke, L. (2012). Bereavement support groups: Breathing life into stories of the dead.

Chagrin Falls, OH: Taos Institute Publications.

Held, B.S. (1996). Back to reality: A critique of postmodern psychotherapy. New York:

Norton.

Hermans, H., & Hermans-Konopka, A. (2010). Dialogical Self Theory. New York:

Cambridge University Press

Holzman, L., & Mendez, R. (Eds.) (2003). Psychological investigations: A clinician's guide

to social therapy. New York: Brunner-Routledge.

Hoffman, L. (1993). Exchanging voices: A collaborative approach to family therapy. London:

Karnac Books.

Håkansson, C. (2009). Ordinary life therapy: Experiences from a collaborative systemic

practice. Chagrin Falls, OH: Taos Institute Publications.

Kabat-Zinn, J. (2005). Wherever you go, there you are. New York: Hyperion.

Kwee, G. T. M. (2013). Psychotherapy by Karma Transformation: Relational Buddhism and

relational practice: Taos Institute: WorldShare Books:

www.taosinstitute.net/psychotherapy-kwee.

Kelly, G.A. (1955) The psychology of personal constructs. (2 Vols.). New York: Norton.

Laing, R.D. (1967). The politics of experience. Penguine/Ballantine Books.

Liegeois, A., Ramsleigh, M., Corveleyn, J., & Burggraeve, R. (Eds.) (2012). “After you!”

Dialogic ethics and the pastoral counseling process. new ethics for care-giving

relationships. Leuven: Leuven University Press.

Lines, D. (2006). Spirituality in counseling and psychotherapy. London: Sage.

24
Lock, A., & Strong, T. (Eds.) (2012). Discursive perspectives in the therapeutic practice.

New York: Oxford University

Madigan, S. (2011). Narrative therapy. Washington, DC: American Psychological

Association.

Madigan, S., & Epston, D. (1995). From ‘spy-chiatric’gaze to communities of concern: From

professional monologue to dialogue. In S. Friedman (Ed.) The Reflecting Team in

Action. (pp. 257-276). New York: Guilford Press.

Maturana, H. (2008) The biological foundations of virtual reality and their implications for

human existence. Constructivist Foundations. 3: 109-114.

McCoy, B. (2013). Youth ministry from the inside out: How relationships and stories shape

identity. Downer’s Grove, ILL: Intervarsity Press.

McCown, D. (2013). The ethical space of mindfulness in clinical practice: An exploratory

essay. Philadelphia: Jessica Kingsley.

McLeod, J. (1997). Narrative and psychotherapy. London: Sage.

McNamee, S., & Gergen, K.J. (Eds.) (1992). Therapy as social construction. London, UK:

Sage.

McNamee, S. (2004). Promiscuity in the practice of family therapy. Journal of Family

Therapy, 26, 224-244.

Mitchell, S. (1988). Relational Concepts in Psychoanalysis: An Integration. Cambridge, MA:

Harvard University Press.

Neimeyer, R.A. & Raskin, J.D. (2001). Varieties of Constructivism in Psychotherapy. In K.

Dobson (Ed.), Handbook of cognitive-behavioral therapies (2nd ed., pp. 393-430).

Guildford: New York.

Ness, O., Borg, M., Semb, R., & Karlsson. B., (2014). “Walking alongside:” Collaborative

practices in mental health and substance use care. International Journal of Mental

25
 Health Systems, 8, 55.

O’Hanlon, W.H., & Weiner-Davis, M. (1989). In search of solutions: A new direction in

psychotherapy. New York: Norton.

Paré, D. (2013). The Practice of Collaborative Counseling and Psychotherapy: Developing

Skills in Culturally Mindful Helping. London: Sage.

Parker, I. (Ed.) (1998). Social construction, discourse and realism. London: Sage.

Penn, P. (2009). Imaginations: Writing and language in therapy. Chagrin Falls, OH: Taos

Institute publications.

Quintas, C.S. (2013). Ohana and the creation of a therapeutic community. Taos Institute:

WorldShare Books: www.taosinstitute.net/ohana-and-the-creation-of-a-therapeutic-

community.

Randall, W.L. (2014). The Stories We Are: An Essay on Self-Creation. 2nd. Ed. Toronto:

University of Toronto Press.

Riikonen, E. & Smith, G.M. (1997) Re-Imagining Therapy: Living Conversation and

Relational Knowing. London: Sage.

Sarbin, T.R. (Ed.) (1986). Narrative psychology: The storied nature of human conduct. New

York: Praeger.

Seikulla, J. & Arnkil, T.E. (2006). Dialogical meetings in social networks. London: Karnak.

Seikkula, J., Aaltonen, J., Alakare, B., Haarankangas, K., Keränen, J., & Lethinen, K. (2006).

Five-year experience of first episode nonaffective psychosis in open dialogue

approach: Treatment principles, follow-up outcomes and two case studies.

Psychotherapy Research, 16, 214–228.

Shotter, J. (1993). Conversational realities. London, Sage.

Shotter, J. (2008). Conversational realities revisited. Chagrin Falls, Ohio: Taos Institute

Publications.

26
Sluzki, C. E. (1992). Transformations: A blueprint for narrative changes in therapy. Family

Process, 31, 217-230.

Snyder, M. (1996) Our “other history”: Poetry as a metaphor for narrative therapy. Journal of

Family Therapy, 18, 337-359.

Strong, T., Sutherland, O., & Ness, O. (2011). Considerations for a discourse of collaboration

in counseling. Asia Pacific Journal of Counseling Psychotherapy, 2, 25-40.

Strong, T. & Paré, D. (Eds.) (2004). Furthering Talk: Advances in the Discursive Therapies.

New York: Springer.

Szasz, T.S. (l96l). The myth of mental illness: Foundations of a theory of personal conduct.

New York: Hoeber-Harper.

Tomm, K. (1999). Co-Constructing responsibility. In S. McNamee & K.J. Gergen &

Associates, Relational Responsibility: Resources for Sustainable Dialogue (pp. 129-

138). Thousand Oaks CA: Sage.

Tomm, K., St. George, S., Wulff, D., & Strong, T. (Eds.) (2014). Patterns in interpersonal

interactions: Inviting relational understandings for therapeutic change. New York:

Routledge.

Von Glasersfeld, E. (1995). Radical Constructivism – A Way of Knowing and Learning.

New York: Routledge.

Watzlawick, P., Beavin, J.H., & Jackson, D.D. (1967). Pragmatics of human communication.

New York: Norton.

Weingarten, K. (1998). The small and the ordinary in the daily practice of a postmodern

narrative therapy. Family Process, 37, 3-15.

White, M. (2011). Narrative practice: Continuing the conversations. New York: Norton.

White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton.

Wittgenstein, L. (1953). Philosophical investigations. (Trans. G. Anscombe). New York:

27
 Macmillan.

Witkin, S. (Ed.) (2011). Social construction and social work practice. New York: Columbia

University Press.

For the glossary:

Social construction: As a general theory of knowledge, it is proposed that all accounts of the

real, the rational, and the good find their origins in social communities. Thus, all candidates

for truth – whether in science, religion, or everyday life are the outcomes of culturally and

historically situated social interchange. As a vocabulary of practice, the attempt is to put such

views into social use, for example, in furnishing insights and inspiration in developing new

forms of research, along with dialogic and collaborative practices in therapy, organizational

change, education, and conflict resolution.

28