Chapter 13: Postmodern Approaches

What came before modernism?

Romanticism and Realism, which dominated the 19th century

Romanticism (c. 1800-1850)

This movement valued emotion, imagination, and the beauty of nature, often in contrast to the growing industrial world. It was a rebellion against the Enlightenment's emphasis on reason.

Realism

Modernism

• Modernists believe in the ability to describe objective reality accurately and assume that it can be observed and systematically known through the scientific method.

• They also believe reality exists independent of any attempt to observe it. Modernists believe people seek therapy for a problem when they have deviated too far from some objective norm.

Postmodernism

• Postmodernists do not believe realities exist independent of observational processes and of the language systems within which they are described.

• Rejecting the idea that there is a reality that is scientific, objective, and understood

Deconstruction to Co-construction

• For some social constructionists, the process of “knowing” includes a distrust of the dominant cultural positions that permeate families and society today. Particularly when the dominant culture exerts a destructive impact on the lives of those who live beyond the margins of what is generally considered normal.

• Change begins by deconstruction

Social constructionism

is psychological expression of this postmodern worldview; it values the client’s reality without disputing whether it is accurate or rational (Gergen, 1991, 1991)

• To social construcionists, any understanding of reality is based on the use of language and is largely a function of the situations in which people live. Our knowledge about reality is socially constructed

1. Clients are viewed as experts about their own lives.

2. Modernists believe reality exists independent of any attempt to observe it.

3. Values the client’s reality without disputing whether it is accurate or rational.

The two most significant approaches

1. solution-focused brief therapy (SFBT)

2. narrative therapy

The Collaborative Language Systems Approach

• People stuck in dialogic system that has a unique language, meaning, and process.

• Clients become the experts who are informing and sharing with the therapist the significant narratives of their lives.

• Therapist–client conversation evolves into a dialogue of new meaning, constructing new narrative possibilities.

Social Constructionism Therapy Goals

• Generate new meaning in the lives of clients.

• Co-develop, with clients, solutions that are unique to the situation.

• Enhance awareness of the impact of various aspects of the dominant culture on the individual.

• Help people develop alternative ways of being, acting, knowing, and living.

Unique Focus of SFBT

• Behavior change is viewed as the most effective approach to assisting people in enhancing their lives.

• Past is downplayed, while present and future are highlighted.

• Clients choose the goals they wish to accomplish; little attention is given to diagnosis, history taking, or exploring the emergence of the problem.

  • Look at what do client’s want to accomplish

  • Very positive oriented

SFBT: Positive Orientation

The idea that people are healthy and competent

• SFBT has parallels with positive psychology.

• Concentrates on what is right and what is working rather than dwelling on deficits, weaknesses, and problems.

  • Focus on what is right and what is working

SFBT: Looking for What is Working

• Therapists concerned on what is working.

• Assist clients in paying attention to the exceptions to their problem patterns, or their instances of success.

• Assist clients to discover exceptions, or times when the problem is less intrusive in their life.

Exceptions

times when the problem is less intrusive in their life

SFBT: Basic Assumptions Guiding Practice

• Clients do have the capability of behaving effectively.

• Advantages to a positive focus on solutions and on the future.

• Exceptions to every problem.

• Clients often present only one side of themselves.

  • Ex: if you say “I am such a failure.”

    • Therapist will ask you to think of a time where you did not fail.

• No problem is constant, and change is inevitable.

• Clients are doing their best to make change happen.

• Clients can be trusted in their intention to solve their problems.

SFBT: Characteristics of Brief Therapy

• Rapid working alliance between therapist and client

• Clear specification of achievable treatment goals

• Clear division of responsibilities between client and therapist

  • Share responsibility

• Emphasis on client’s strengths, competencies, and adaptive capacities

• Expectation that change is possible and realistic and that improvement can occur in the immediate future

• Time-sensitive

SFBT: The Therapeutic Process

• Clients are given an opportunity to describe their problems.

• The therapist works with clients in developing well-formed goals.

• Clients are assisted in exploring the exceptions.

• The therapist offers clients summary feedback and provides encouragement and suggestions.

• The therapist and clients evaluate the progress being made in reaching satisfactory solutions.

Customer-type relationship

Client and therapist jointly identify a problem and a solution to work toward.

• They work hard and want to get the product of counseling

Complainant relationship

A client describes a problem but is not able or willing to take an active role in constructing a solution.

• “Yes, but” client

Visitors

Clients come to therapy, because someone else thinks they have a problem.

Therapeutic Techniques and Procedures

1. Pre-therapy change

Therapists asks, “What have you done since you made the appointment that has made a difference in your problem?”

Therapeutic Techniques and Procedures

2. Exception questions

Therapists direct clients to times in their lives when the problem did not exist.

Therapeutic Techniques and Procedures

3. The miracle question

Therapists ask, “If a miracle happened and the problem you have was solved, how would you know it was solved, while you were asleep, what would be different in your life?”

Therapeutic Techniques and Procedures

4. Scaling questions

Therapists ask, “On a scale of zero to 10, how would you rate your anxiety now?”

Therapeutic Techniques and Procedures

5. Formula first session task

Homework a therapist gives clients between their first and second sessions that offers hope that change is inevitable.

Therapeutic Techniques and Procedures

6. Therapist feedback to clients

Therapists take a short break during each session to write a summary for clients.

Therapeutic Techniques and Procedures

7. Terminating

Termination begins at the first session.

SFBT: Application of Group Counseling

• Practitioner believes that people are competent and able to solve their own problems.

• Facilitator focus on solutions where group members can give an opportunity to describe their problems briefly.

• Goals for therapy are small, realistic, and achievable.

• Group leaders use questions that change but remain goal-directed and future-oriented.

• Group context helps the members learn about their personal abilities to resolve their own concerns.

• Shifts the focus from what’s wrong in lives to what’s working for them.

Motivational Interviewing

A humanistic, client-centered, psychosocial, and modestly directive counseling approach involving:

1. Person-centered therapy

2. Solution-focused brief therapy

MI spirit- bedrock attitude of therapists as they apply their skills based on a person-centered philosophy

Basic Principles of Motivational Interviewing

1. Therapists strive to experience the world from client’s perspective without judgment or criticism

2. MI is designed to evoke and explore both discrepancies and ambivalence

3. Reluctance to change is viewed as an expected part of the therapeutic process

4. Practitioners support clients’ self-efficacy

5. Clients may express a desire and ability to change

• Do not look at it as “resistance”

• By talking to the cousnelor, the counselor is motivated to explore their stories.

Common Ground of Motivational Interviewing with Solution-Focused Brief Therapy

• Nonpathological, Health-Promoting Emphasis

  • Not about sickness

• Reframing Resistance

  • As a natural process

• Use of Client Strengths and Resources

• Skills Improve with Deliberate Practice

Narrative Therapy

Key Concepts: What do therapists do?

Therapists:

1. listen to clients with an open mind.

2. encourage clients to share their stories.

3. listen to a problem-saturated story of a client without getting stuck.

4. demonstrate respectful curiosity and persistence.

5. believe the person is not the problem, but the problem is the problem.

The Therapeutic Process in Narrative Therapy

• Collaborate with the client in identifying (naming) the problem.

• Personify the problem and attribute oppressive intentions.

  • The problem is a beast in itself, learn to externalize

• Investigate how the problem has been disrupting or dominating the person.

• Search for evidence of the problem.

• Ask clients to speculate about what kind of future they could expect from the competent person that is emerging.

• Create an audience for perceiving and supporting the new story.

Function and Role of the Narrative Therapist

• To become active facilitators

• To demonstrate care, interest, respectful curiosity, openness, empathy, contact, and fascination

• To believe in the client’s abilities, talents, and positive intentions

• To adopt a not-knowing position that allows being guided by the client’s story

• To help clients construct a preferred story line

• To create a collaborative relationship—with the client being the senior partner

Narrative Therapy

Application: Therapeutic Techniques and Procedures

• Used to generate experience rather than to gather information

• Always asked from a position of respect, curiosity, and openness, and from a not-knowing stance

• Are used to assist clients in exploring dimensions of their life situations

• Can lead to taking apart problem-saturated stories

Externalization

A process of separating the person from identifying with the problem.

• Externalizing conversations help people

  • to map the influence of the problem in the person’s life.

  • to map the influence of the person’s life back on the problem.

Mind Maps

Separating the person from the condition

Deconstruction and Creating Alternative Stories

• Problem-saturated stories are deconstructed before new stories are co-created.

• The assumption is that people can continually and actively re-author their lives.

• Unique possibility questions enable clients to focus on their future.

• An appreciative audience helps new stories to take root.

Narrative Therapy

Application to Group Counseling

• Narrative therapy has been used for group work in school settings.

• Emphasis on creating an appreciative audience for new developments in their lives.

• New identities can be rehearsed and tried out into a wider world.

• Wide range of uses for group-based narrative therapy in schools including

  • getting back on track in schoolwork.

  • anger management.

  • grief counseling.

  • an adventure-based program.

Postmodern Approaches: Strengths From a Diversity Perspective

Social constructionism is congruent with the philosophy of multiculturalism.

• Clients are encouraged to explore how their realities are being constructed out of cultural discourse and the consequences that follow from such constructions.

• Narrative therapy is grounded in a sociocultural context.

Postmodern Approaches: Shortcomings From a Diversity Perspective

• Adopting a “not knowing” stance may lead clients from some cultures to lose confidence in the therapist.

• Postmodern-oriented therapists must convey to clients that they have expertise in the process of therapy, but clients are the experts in knowing what they want in life.

  • Therapists can say: “My expertise is in the process, your expertise is in your story”

Contributions of Postmodern Approaches

• A major strength of SFBT and narrative therapy is the use of questioning, the centerpiece of both approaches.

• Brief therapy has been shown to be effective for a wide range of clinical problems.

Limitations and Criticisms of Postmodern Approaches

• Therapists must be skilled in implementing brief interventions.

• Therapists may employ techniques in a mechanistic fashion.

• Reliance on techniques may detract from building a therapeutic relationship.

  • Draws comparisons between the exceptions and problems, the counselor has to be very smart

• Narrative therapists must be careful to approach client’s stories without imposing a preconceived notion of the client’s experiences.

• For some clients, the therapist’s “not-knowing” stance may compromise their confidence in the therapist as an expert.

• Emphasis on creating context for providing culturally responsive services.