postmodern approaches
Postmodern Approaches
Some Contemporary Founders of Postmodern Therapies
Collective Effort: Postmodern approaches do not have a single founder; they were developed through contributions from multiple individuals who shared similar philosophical stances. The emphasis is on the collaborative and evolving nature of knowledge.
Highlighted Therapists:
Solution-Focused Brief Therapy (SFBT): Co-founders Steve de Shazer and Insoo Kim Berg are credited with developing this approach at the Brief Family Therapy Center in Milwaukee during the 1970s and 1980s.
Motivational Interviewing (MI): Primarily founded by William R. Miller and later significantly developed with Stephen Rollnick. Miller first introduced MI in the early 1980s, applying it initially to the treatment of problem drinkers.
Narrative Therapy: Two co-founders, Michael White (from Australia) and David Epston (from New Zealand), developed this approach in the 1980s, emphasizing the stories people tell about their lives and the meanings they derive from them.
Introduction to Social Constructionism
Each counseling and psychotherapy model presented has its own version of "reality," suggesting that truth is not absolute but is constructed within specific social and cultural contexts.
Multiplicity of Truths: Acknowledges the coexistence of multiple and often conflicting truths within a postmodern worldview. This challenges the modernist idea of a single, objective reality discoverable through empirical means. It asserts that what is considered "true" or "real" is a product of social interaction, language, and cultural practices.
Skepticism of Singular Theories: Postmodernism expresses doubt that a universal, overarching theory can ultimately explain the complexities of human behavior and social systems. Instead, it favors localized, context-dependent understandings.
Postmodern vs. Modernist Views:
Modernists:
Believe in an objective reality that can be observed, measured, and accurately described through scientific methods. This perspective often seeks universal laws and principles to explain phenomena.
Problems are typically viewed as deviations from established norms or healthy functioning (example: feeling excessive sadness for prolonged periods might be pathologized as depression, signifying a departure from normal emotional states). Solutions often involve bringing the individual back to the norm.
Postmodernists:
Rejects the notion of an independent existence of realities outside of observational processes and language systems. Reality is not discovered but actively created through social interaction and narrative.
Acknowledge that definitions of self, identity, and problems are profoundly affected by cultural norms, societal discourses, and language, which in turn shape individual experiences and interpretations. This view emphasizes the subjective nature of experience.
Social Constructionism: A psychological reflection of the postmodern worldview that profoundly values client reality, actively avoiding disputes about accuracy or rationality (Gergen, 1991, 1999; Weishaar, 1993). It shifts the focus from an individual's internal psychological state to understanding how individuals create meaning in their lives through social interaction and language.
Emphasizes that our understanding of reality is deeply language-dependent and shaped by situational and cultural contexts. Language is not merely a tool for describing reality but a fundamental means by which reality is constructed.
Example: A person might adopt a 'depressed' identity not just due to internal biological or psychological factors, but also because of the cultural acceptance and medicalization of depression as a recognized condition. This identity can then profoundly influence how they perceive their experiences, potentially leading them to discount or overlook positive experiences like good moods, framing them instead as temporary reprieves from an overarching "depressed" state.
Historical Glimpse of Social Constructionism
Historical Shift: Influential psychologists such as Sigmund Freud, Alfred Adler, and Carl Jung initiated significant paradigm shifts in modern psychology over a century ago by offering new ways to understand the human psyche and mental health. Their theories, while foundational, often sought universal truths.
21st Century Shift: Postmodern constructions are reshaping psychotherapy by moving away from grand theories and towards more localized, context-dependent, and collaborative approaches. This shift acknowledges the role of language, culture, and power in shaping individual experiences and psychological distress.
Socially Storied Lives: This concept involves ideating change away from a self-centric modernist conception of truth (where truth resides solely within the individual or in objective facts) towards collaborative storytelling and the integration of diverse perspectives. Therapy becomes a space for co-authoring new, more empowering narratives about one's life.
Challenging Dominant Cultures: Postmodern approaches often express a distrust of dominant societal values, discourses, and power structures, particularly in the context of their negative implications for marginalized individuals (White & Epston, 1990). This includes questioning how societal norms define problems, mental illness, and appropriate ways of being, and how these norms can oppress or disadvantage certain groups.
The Collaborative Language Systems Approach
Dialogue in Therapy: Therapy is viewed as a unique conversational system where clients and therapists collectively organize and resolve issues through dialogue. The emphasis is on the co-creation of meaning and solutions, rather than the therapist having the sole expertise.
Therapist Position: Therapists engage from a ‘not-knowing’ perspective, fostering genuine curiosity and discovery. This means the therapist avoids acting as an expert who diagnoses or unilaterally prescribes solutions. Instead, they position themselves as learners, genuinely interested in the client's unique experiences and interpretations.
This approach encourages clients to share their narratives as the true experts of their lives, empowering them to find their own solutions and meanings rather than relying on the therapist's interpretations.
Technique Similar to Socratic Method: This approach involves engaging with clients through questioning to help them derive their own meanings and insights while allowing for therapeutic exploration without predetermined outcomes (Anderson & Goolishian, 1992). The therapist's questions are designed to open up new possibilities and perspectives.
Purpose: The primary goal is to facilitate a storytelling process where new meanings, alternative perspectives, and previously unrecognized strengths or resources can emerge organically from the client's narrative.
Solution-Focused Brief Therapy (SFBT)
Overview: A future-oriented, goal-driven therapy developed by Steve de Shazer and Insoo Kim Berg. It originated at the Brief Family Therapy Center in Milwaukee in the late 1970s, which became a leading center for brief therapy training and research.
Unlike traditional therapies that often dwell on the past or problems, SFBT is designed to be efficient and effective, typically involving only a few sessions.
Core Philosophy: Focused on identifying and amplifying client strengths, resources, and exceptions to their problems rather than delving into the origins of problem histories. It operates on the belief that clients already possess the resources and strengths needed to solve their problems.
Optimistic, antideterministic approach advocating client potential for change (Grothaus et al., 2019). It assumes that change is constant and inevitable, and that clients are inherently capable of constructing solutions.
Influential Figures: Milton Erickson greatly inspired the development of SFBT through his innovative practices emphasizing client strengths, unconscious resources, and the utility of brief, often indirect, interventions. Erickson's work demonstrated that significant change could occur quickly by focusing on what works and what is possible.
Key Processes:
Ignores past causes and etiologies of problems in favor of concentrating on present efforts and future solutions. The question is not "Why did this happen?" but "What will be different when the problem is solved?"
Discussions are centered collaboratively on clients' desired goals and preferred futures, with minimal emphasis on gathering traditional diagnostic information or detailed problem histories. The focus is always on what the client wants to achieve.
Key Concepts Unique to SFBT
Problem vs. Solution Orientation: This involves a deliberate and radical shift from focusing on the nature, severity, or causes of problems to identifying and amplifying existing strengths, successes, and desired future states. Instead of asking "What's wrong?", SFBT asks "What's working?" or "What do you want instead?".
Behavioral Change: Emphasis is primarily on changing specific behaviors and interactions as the main avenue for enhancing life quality. Small, concrete behavioral changes are seen as catalysts for larger, systemic shifts.
Client Empowerment: SFBT holds a strong belief in client capabilities to identify and enact their own change. The therapist's role is not to "fix" the client but to facilitate the client's own problem-solving abilities, thus creating a collaborative goal-setting process and a therapeutic dialogue that respects client autonomy.
Positive Orientation: Clients are consistently viewed as healthy, competent, and resourceful individuals who are capable of discovering and implementing their own solutions. This positive reframing helps clients recognize their own agency and potential.
The Therapeutic Process in SFBT
Goal Setting / Preferred Future (Pre-session Change): The session often begins by asking about any positive changes noticed since scheduling the appointment or what they hope to get out of therapy. Clients then narrate their current issues, and the therapist validates their experience without dwelling on problem details.
Developing Specific Goals: Collaborative development of specific, measurable, achievable, relevant, and time-bound (SMART) goals or preferred futures. Therapists use questions like "What will be different when the problem is solved?" or "What would you be doing instead?"
Identifying Exceptions: Therapists help clients identify exceptions – times when the problem was less severe or absent, or when they successfully managed a difficult situation on their own. This highlights existing strengths and resources. "When did you manage to cope with this issue, even slightly?"
End-of-Session Feedback and Tasks: Therapists conclude sessions with summary feedback, genuine encouragement, and often suggest small, concrete tasks for clients to observe or do between sessions (e.g., "notice what you would like to continue happening").
Progress Rating: In subsequent sessions, clients rate their progress towards their goals using a scaling question (e.g., "On a scale of to …"), which informs future interventions and helps track observable improvements.
Motivational Interviewing (MI)
Introduction: Developed by clinical psychologists William R. Miller and Stephen Rollnick in the early 1980s, MI is a directive, client-centered counseling style for eliciting behavior change by helping clients explore and resolve ambivalence. It is rooted in a humanistic, person-centered approach, emphasizing respect for client autonomy and fostering a collaborative spirit.
Core Aspects:
Primarily designed to enhance intrinsic client motivation for change, particularly effective in situations where clients are ambivalent or resistant to change regarding problematic behaviors. It's especially relevant for addressing substance use disorders (e.g., alcohol use), mental health issues, chronic disease management, and promoting adherence to health behaviors.
MI works by helping clients articulate their own reasons for change (change talk) and strengthening their commitment.
Key Skills of MI (OARS): These form the foundation of MI practice:
Open-ended questions: Encouraging clients to elaborate beyond simple 'yes' or 'no' responses, promoting deeper exploration of their perspectives and experiences.
Affirmations: Recognizing and affirming client strengths, efforts, and intentions, which builds self-efficacy and rapport.
Reflective listening: Carefully listening to and reflecting back the client's statements, especially 'change talk,' to ensure understanding and deepen client self-exploration. This is a core skill for empathic communication.
Summaries: Periodically summarizing the client's expressed feelings, thoughts, and plans, particularly focusing on their 'change talk,' to reinforce motivation and clarify understanding.
Support client self-efficacy: Fostering the client's belief in their own ability to succeed in making changes, often by drawing on past successes and identifying personal strengths.
Narrative Therapy
Founders: Michael White and David Epston, recognized for emphasizing the significance of personal narratives and stories in therapeutic practice. They developed this approach as a way to help people reclaim their lives from problem-saturated stories.
Key Concepts:
Individuals construct their realities and identities through the stories they tell about their lives, these narratives are profoundly shaped by cultural norms, societal expectations, and language. Problems often arise when people internalize dominant, problem-saturated narratives that limit their sense of self and possibilities.
The primary aim is to empower clients to redefine their identities and resist negative labels or oppressive cultural narratives. This involves helping clients externalize their problems (seeing the problem as separate from themselves) and discover alternative, more empowering life stories.
Therapeutic Process: Narrative therapy engages clients in respectful dialogues about their life stories. The process involves:
Externalization: Helping clients separate themselves from their problems, naming the problem as an external entity (e.g., "the depression" instead of "I am depressed"). This reduces shame and opens up space for action.
Mapping the Influence of the Problem: Exploring how the problem has affected the client's life and relationships.
Mapping the Influence of the Person: Identifying times when the client successfully resisted or acted against the problem's influence, highlighting their unique skills, values, and commitments.
Searching for Unique Outcomes: Discovering "sparkling moments" or exceptions where the client managed without the problem or made progress.
Co-authoring New Stories: Assisting clients in identifying their strengths, skills, and values, and then using these to create "counter stories" that redirect their narratives from problem-saturated descriptions to accounts of recovery, resilience, and preferred futures. This involves creating documents (like letters or certificates) or ceremonies to reinforce these new narratives.
Practical Implication of Postmodern Approaches
Reliance on socio-cultural contexts underscores the intricate intersections between personal experiences and broader narratives. This leads into the exploration of systemic issues affecting clients, such as the impact of gender roles, cultural expectations, or socio-economic disparities on an individual's well-being and problem definitions. Postmodern therapists are keenly aware of how power dynamics and social discourses shape individual lives.
Diversity Considerations: The multicultural aspects of these frameworks make them particularly adaptable therapeutic practices. They inherently recognize and respect diverse client backgrounds, cultural values, and belief systems. By valuing the client's unique reality and narrative, these approaches enable the co-creation of stories that empower change in ways that are culturally congruent and meaningful to the individual. They avoid imposing a universal standard of "normalcy" or "health."
Conclusion: Contributions & Limitations
Contributions: Postmodern therapies have made valuable contributions by offering non-pathologizing, resource-oriented approaches in therapy. They prioritize client expertise, agency, and a collaborative stance, moving away from a medical model that often labels and diagnoses. They emphasize short-term, present- and future-focused interventions, making therapy more accessible and efficient for many clients.
Limitations: Effective practice requires skilled practitioners who are adept in facilitating brief interventions and establishing a robust therapeutic relationship quickly. Therapists need to be comfortable with ambiguity, open-ended dialogues, and relinquishing the traditional "expert" role. There can also be challenges in applying these purely postmodern approaches to clients who prefer more structured guidance or who are seeking definitive answers and diagnoses. Some critics argue that by de-emphasizing pathology, these approaches might overlook severe psychological distress that requires more direct intervention.
Applications in Therapy Sessions
Case Example: The note illustrates the practical application of both solution-focused methods and narrative approaches in case studies with clients such as Stan and Gwen.
For example, with Stan, a solution-focused approach might involve using scaling questions ("On a scale of to , how hopeful are you today?") to track progress and identify small steps forward, and solution-talk to discuss what life would look like without the problem.
With Gwen, a narrative approach might emphasize externalization (e.g., "It sounds like 'The Guilt Monster' has been trying to control your decisions") to separate Gwen from her feelings of guilt, and narrative reframing to help her construct a new story of resilience and agency, rather than one of being defined by past mistakes. These techniques empower clients to see their problems differently and discover their own capabilities for change.
Reflection Questions
Contemplate the effectiveness of integrating solution-focused techniques (e.g., miracle question, scaling questions, exception-finding) in other therapy contexts, such as cognitive-behavioral therapy or psychodynamic therapy.
Consider the implications of using narrative therapy's core principles (e.g., externalization, re-authoring conversations) in reaching diverse client populations, including those from non-Western cultures where storytelling traditions may differ.
Discuss how the key techniques from these postmodern therapies (e.g., 'not-knowing' stance, OARS from MI, externalization from narrative therapy) could enhance your existing approach in clinical settings.