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New Dimensions of Effectiveness in Therapy
Paul Beckow M.Sc, R.P.C., Individual, Couple, Family Therapist
Re-printed from the Journal of Clinical Counsellors Association and the Healing Exchange Magazine. June 1997.
“The transition from a particular paradigm to a new one from which a new tradition of science can emerge is far from an accumulative process, one that can be achieved by the old ways of thinking. Rather it is the reconstruction of the field from new fundamentals, a reconstruction which alters some of the field’s most theoretical generalizations as well as its methods and its approaches. When the transition is complete the profession will have changed its view of the field, its methods, its goals.”
Thomas Kuhn, The Structure of Scientific Revolutions
Developments in scientific thinking in this century, particularly in the fields of linguistics, cybernetics, systems theory, epistemology and the philosophy of science are making an enormous contribution to many areas of human potential. This contribution is creating exciting new possibilities in the practice of psychotherapy.
There exists a new stream of thought that is leading many practicing therapists away from the traditional models and approaches to more innovative forms of therapeutic response and treatment. These approaches are generating rapid, profound, and powerful treatment outcomes.
Take Psychiatrist Dr. Robert Shaw, who is very much a part of this new stream of thought and practice. Trained at the University of Pennsylvania and Mount Sinai hospital, Dr. Shaw is now director of the Berkeley Family Institute in California. He is acknowledged throughout the U.S. and Canada for his accomplishments in the field of individuals, couple, and family therapy. He is best known for creating the approach known as “Contextual Therapy”.
The following is based upon my experience of some of the principles of Dr. Shaw's work.
What are some of the results being reported as a result of new innovations in the practice of therapy? To begin with, the recovery of well being and the discovery of one's personal resources are being recognized as much more accessible than previously thought. In these new therapeutic processes, there is an ease and naturalness mutually established between therapist and client. Powerful shifts in the clients views can occur in any moment.
To quote Dr Shaw:
"As a result of the possibilities made available by these newly-established assumptions in the practice of therapy, we are seeing not only a greater feeling of freedom and creativity on the part of therapist and client, but we are achieving more rapid and consistent results in our work together.”
As a result of these new views, therapy, rather than being viewed as a technical undertaking proceeding from some established diagnosis, becomes a fulfilling, creative endeavor, generating individual approaches to each individual client and the various issues the client brings to therapy.
Constructivism: a new organizing principle:
What is the manner of thinking that is producing these new possibilities in the practice of therapy? It is a body of thought that is focused upon the notion that perception, the process by which we know what we know about our world, is not a passive affair. This view proposes, contrary to prevailing tradition, that our perception does not work like a camera encoding external data or capturing some true and accurate picture of some objective reality.
This theory of Constructivism asserts that the content and the texture of our experienced reality is not externally generated, but it is instead created internally, within ourselves. Our reality is constructed by us in the way our internal nervous system interprets the stream of undifferentiated signals that come to us form the external world.
Many leading thinkers (Piaget, Maturana, and Von Forrester) seem to agree that we create objects or independent entities by an act of distinction within our nervous system that separates the object with its particular “qualities” from a background which in turn has its own particular qualities. It is our own internal organization of external stimuli which “brings forth” worlds in which objects as we know them can exist.
Thus the nature of our reality reflects the internal distinctions we have made. Witness the Inuit who report that they “see’ and “know of” 26 different kinds of snow, each type of snow different from the other. Each type of snow having distinct significance in Inuit daily affairs. Consider the story of the African native who, upon looking at a photograph of himself, reports that he sees only dots of various colours. For someone from a culture which does not communicate to its members that the series of dots can be interpreted as a picture, there simply is no picture. It does not "exist".
In the Constructivist view, our awareness of the objects making up our world happens first through our interacting with stimuli from the environment and further the understanding of this awareness is passed on to other members of our culture through the use of language. In other words, it is the distinctions we make, that are expressed through our words and our actions, that then shapes and molds what we come to see as the reality we live in. Constructivism does not imply that the universe is simply imaginary, but it does suggest that the shapes, colors, patterns, and textures of our world, and above all, its meanings, are generated by the workings of our own internal systems.
We Construct our World
From the point of view of psychotherapy, the Constructivist model has profound significance. Seeing the world as a self-creation opens us up to options which are not available to those who view the world as fixed and out there, somewhere, beyond the range of our influence. In fact seeing the world as a self-creation opens the door to our own self-empowerment. It becomes in fact, the epitome of self-empowerment, for an experienced reality that we have ourselves created must surely be there to be formed and shaped by us in many new ways. If our personal reality is “constructed” through our interacting with and communicating about our environment, then this leaves us a liberal degree of scope for change and adaptation.
Human beings make distinctions among various stimuli, thereby endowing an object, event, or idea with certain meanings or associated meanings. Our sense of what things "mean" gives us our experience of the world and our actions. If we see a scowl on someone's face, to some this may mean "danger = annoyed person." To others it may mean "some one having indigestion " or "someone in need of water." Meanings are pirmary in interpreting and responding to "reality."
So our personal realities can change as meanings change. Depending on the way we frame and attribute meaning to the events that compromise our lives, the various events we perceive can have very different meanings for us and therefore trigger very different feelings, associations, and alternative responsive behaviors.
For example, today we have a particular set of experiences, thoughts, and responses if we should find ourselves in a restaurant sitting near a cigarette smoker. Had this occurred twenty years ago, however, the reality which appeared would have been quite different. Our perceptions shift as our distinctions and attributed meanings shift.
It is this act of creativeness in constructing our own realities that is producing the room for new approaches being undertaken by psychotherapists. In the words of Dr. Shaw:
"In the traditional manner of responding to emotional disturbance as therapists we have acted as though we are fixing some external generated condition or problem that our client “has”. This leads to making a diagnosis, prescribing a plan, and giving treatment. Most models of psychotherapy are founded upon this model. This is the medical model.
But what happens when we construct a therapy that is founded upon the idea that reality is to a large extent interpretive, that we cannot know any absolute truth about some objective world? To the extent that reality can be seen as interpretive, we have room to generate some very new possibilities when meeting with clients. In this model, clients are simply responding to events in their life and their problems can be seen to be in the construction of their reality - a description that gives them very little power or freedom to respond to their situation.
Therapy therefore becomes a continuing act of constructing points of view from beginning to end. When we are no longer attached to finding our some truth about what is wrong with the client, we can place our attention on generating various points of view that afford the client the freedom to be and the capacity to act effectively in their circumstances.
Therapy becomes a different kind of activity when governed by the constructivist paradigm. And we have discovered there is some real power to proceeding this way.”
The Client's Impasse
A commitment to viewing nature as a “constructed personal reality” provides therapists, then, with a theoretical basis for seeing their work as a process of creating new and individually-designed therapeutic realities. Whatever difficulty brings a client to see a therapist no longer needs to be viewed as an expression of some deficit or pathology, but can instead be seen as simply a problem that he or she is in the process of interpreting – a complaint. By and large all complaints can be viewed from two broad points of view:
1.Things are going wrong. That is, the particular circumstances in life are an impairment to well-being rather than an opportunity for growth and development.
2.The client has no power in the situation and is attributing his or her condition to some defects in power, capacity, skill, knowledge, or personality. Power is usually projected onto the characters or circumstances in the client’s life.
So the client enters therapy with a complaint. Things are going wrong and he or she speaks as though they lack the power to act effectively, constructively. The person arrives at therapy having truly exhausted all the possible responses within his or her constructed reality. Within the presuppositions that make up their reality, the client is stuck.
It could be seen that all personal realities are founded upon certain fundamental notions or presuppositions. And for the most part the beliefs that hold any particular reality in place are held unconsciously, beyond the range of personal awareness. It can be seen that when these assumptions are raised to awareness for scrutiny, there exists the opportunity to weigh the particular costs and benefits of holding on to a specific set of assumptions or beliefs. Within the constructivists paradigm a problem can be seen as being the result of simply the influence of a troublesome point of view.
Misunderstandings in the nature of what they are dealing with. And the possibilities of generating new and more functional even enlightening ways of looking are unlimited.
Therapy becomes a process by which the client discovers new “descriptions” of their situations. As a result of this discovery he or she realizes the opportunity is always there to choose new and more useful points of view allowing easy and effective action.
To be satisfying for the client this can occur as a shift from their original view that depicts: “things are going wrong and I have little freedom or power” to a new view that provides opportunities and openings for effective action. The client is free.
When the client views the situation as having arisen as a natural consequence of his or her behavior, attitudes, beliefs, or decisions, then the situation becomes potentially under their control. He or she becomes aware of the possibility of developing new and creative ways of being and operating, then the problem that brought him or her to therapy can simply “dissolve”. What originally was a debilitating crisis can transform into an ordinary problem in the process of living.
Life may not always be the way one thinks it should be, however one can always act or respond constructively with the way life is. This becomes possible through discovering in oneself some sense of the opportunity for creative interpretation.
The Action of Therapy
At the onset the clients come to therapy lacking a satisfactory response to some condition in their world. In their reality they have a situation that is constructed in such a way that there is no satisfactory way for them to respond. The role of the therapist is to conduct a conversation by which a client can create a new reality in which he or she discovers his or her own direction and power to move.
The action of therapy can be that of enlisting the client in views consistent with freedom, satisfaction, joy, workability. The process by which the therapist does that is difficult to explain and teach, however it is possible to give an idea of this process by pointing out some certain general principles of effective “reality construction”.
The Dance of Destabilization
We have described how the therapist loosens the clients grip on their reality structure by revealing the underlying presuppositions that hold a particular reality in place. This is an intentional act and is always done with sensitivity to the immediate connection between the client and the therapist.
In Dr. Shaw’s words: “This is the dance of destabilization. Within a conversation, unattached to how it all turns out, highly committed to something of value occurring, the therapist pokes and explores the limiting presuppositions that are holding the problem in place.
Now the trick here, however is not to turn this type of inquiry into some kind of therapist technique, method, or strategy- so that the encounter remains fluid, open, and authentic to the connections between two human beings. It cannot be a manipulative endeavor. It must be a connected authentic inquiry.”
Now if the therapist has the point of view that the client is free and able, then this will serve immediately to reveal what it is in the client’s point of view that contradicts this. The therapist might be saying something like: “I know that in your view there is something radically wrong. In my view however this is workable. That is you are free to choose and able to respond creatively. Now what is it in your view that you say contradicts this?
This invites the client to look for the underlying notions that are determining the limits and restraints upon him or her.
For example the therapist postulating the client’s freedom and capacity may inquire “But why not. Why can’t you go ahead and do that?” to which the client may respond “Well I’m not ready yet, I need more confidence.” Or “I would but my boss has never listened to me before, why should he now?” to “I just think it won't do any good anyway?”
This reveals the client's presuppositions. As in the examples cited: The clients considers- he must have confidence before he takes action. Or that his boss will do now what he did in the past. Or that "knowing it wont do any good" serves to protect the client from risk of failing.
With each response the client beliefs are raised to awareness so that they may be questioned. This allows the client to consider their commitment to these notions and either take them and live with their consequences or reject them, allowing new options and behavior to emerge. Either way resolves the issue.
From Evaluation to Initiation
There is a further principle in providing a conversation for reality reconstruction. That is, every therapist will want to begin his or her inquiry with the client by leading him or her from the “evaluative mode” to the “initiating mode”. This is a crucial distinction in generative behavior in the course of therapy.
When clients come into therapy and begin to speak they usually begin in an evaluative mode – that is, expressing their description of the problem, their opinions about it, their judgments about what is making all this happen the way it is etc. This is a description about the events or the circumstances of their lives and usually provides explanation as to why things are the way they are. A frustrated woman for example may complain to the therapist, “ I have been trying for years to get my husband to communicate with me, but he never has. It's frustrating and I think I have given up”.
This evaluative mode is a posture somewhat set back and reflective. It discusses how things are. The result of this mode is generally for the client to identify the shortcomings and restraints of the difficulty and present the reasons for the impasse.. The client will offer the presentation of this reality to the therapist hoping to enlist him or her in accepting this description of the problem, to try to get the therapist to solve the problem, or to agree on its impossibility.
This evaluative mode usually focus on deficiencies and seems convinced of the difficulties of the situation. The way the "reality" is portrayed restricts and restraints much of the client's energy – as well as that of the therapist.
This is the complaint. And describing the grounds of the complaint is the descriptive mode.
When the therapist leads the client into an initiating mode there is a shift from describing the problem and telling “how it is” to a reorientation towards a the client's desired result towards the problem.
For example with the client who has complained about her “non communicating husband” the therapist may say: “ I got it. Your husband doesn’t communicate. And what is it you would like from me ? How would you like to be?"
This moves the client into the initiating mode. A thrust toward some desired result in the matter. And produces a rise in the energy that accompanies effort on the behalf of some outcome. This generates a direction for the conversation. When energy becomes mobilized to do something it will often inspire the search for a way of viewing the situation that offers new freedom or capacity in the matter.
This then is the action of therapy. Through the shift to an initiating stance and an exploration of the costs and benefits of holding certain particular beliefs and viewpoints, the client begins to re assess the structure of their reality – and the pluses and minuses of the points of view which hold it together. The client is not stuck with these points of view. They are choices and become revealed as such. A client may discover new resolution:
by letting go of restricting or limiting notions or beliefs
by allowing for the freedom to invent new interpretations, explore new choices, and new actions that are made possible by these altered perspectives.
In a successful therapy session it becomes apparent that specific problems can be dealt with and clients can discover their own capacities in the art of problem solving. Not only does the problem that inspired the visit to the therapist get processed, but the client can learn to generalize the newly discovered ability for “reality construction” to bring to other life issues.
The remarks of Dr. Shaw succinctly describe the opportunity before us:
"In the profession of therapy, there is available to us a new paradigm, a new possibility, that has not previously been available to human beings. And that is, the possibility of living life as the inventor, the creator, of one's realities, ones world. Rather than living life as the discoverers or observers of some fixed objective reality out there.
With a sensing of our capacity to construct points of view, to assign meaning, above all, the ability to alter our own personal realities, human beings can shift from being, in one metaphor, the recorder of their life story, to being the author. There is a client's access to real and creative power.“
Paul Beckow M.Sc., R.P.C., is an individual and family therapist. Paul completed 3 years of postgraduate training with Dr. Robert Shaw at the Berkeley Family Institute. He is presently the Director and principle therapist of the Victoria Family Institute, a center committed to the resolution of conflict and troubling issues in couple and family life.
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For personal or couple counselling, for more information, or to register for a course - please contact Paul Beckow at The Victoria Family Institute.
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