Constructing and deconstructing psychotherapeutic discourse

This paper reviews recent work on the social construction of the self in counselling and psychotherapy, and argues that we need to attend to the ways in which the therapeutic self is fashioned (a) in relation to the ‘psy-complex' as the network of theories and practices concerned with psychological governance and self-reflection in modern Western culture and (b) in the context of ‘therapeutic domains' outside the clinic and academe, domains of discursive regulation and self-expression which then bear upon the activities of professional and lay counsellors. Therapeutic domains contain repertoires, templates and complexes within which counsellors and clients fabricate varieties of truth and story a core of experience into being. I then turn to describe and assess some of the various ways in which this kind of critical reflection on therapeutic discourse and counselling practice now already underpins the work of social constructionist ‘narrative' therapists. Some attention is given to the different pragmatic and deconstructionist approaches which make the discursive constitution of the problem into the problem, either by dissolving or by externalizing the account the client presents. Here I argue that the activities of social constructionist counsellors can be viewed as forms of deconstruction-in-process (a deconstruction of the discursive frames which have been constructed by the client), but that they should not be viewed as stepping outside the discursive conditions of possibility which ground their work. the psy-complex and therapeutic domains still function as relatively enduring structures which limit the degree to which we may construct and deconstruct psychotherapeutic discourse.     

Narrating career, positioning identity: Career identity as a narrative practice

In contrast to traditional definitions of career identity as an individual construct, this article argues for a discursive approach to career identity as a narrative practice. Career identity is conceptualized as a practice of articulating, performing and negotiating identity positions in narrating career experiences. By using the concept of positioning, this approach situates identities within particular historic, cultural and interactional contexts via the discourses and master narratives that position identity. It also leaves space for individual agency and change via the reflexive capacity of the person to modify and negotiate the competing positions available. The methodological implications are considered, and illustrated with an empirical case analysis. The contribution of the proposed approach is in offering contextualized understandings of actual practices, resources and constraints of identity construction while also allowing for in-depth analyses of the particularities of identity work and possibilities for change in careers.     

Subjectivity,Not Personality: Combining Discourse Analysis and Psychoanalysis

Mainstream psychology can often be criticized for turning the liberal concerns of psychologists into conservative practices focusing on the individual. In the United Kingdom, the discursive turn in social psychology has been marked by an audacious body of work critical of cognitive attempts to theorize the social. A particular psycho‐discursive strand has emerged, which combines discourse analysis and psychoanalytic theory in an attempt to change both the subject of, and the subjectivity (re)produced by, mainstream psychology. This paper reviews three different psycho‐discursive approaches: (i) Hollway and Jefferson's Free Association Narrative Interview method; (ii) Billig's Psychoanalytic Discursive Psychology; (iii) Parker's Lacanian excursions into social psychology. In these psycho‐discursive approaches, ‘subjectivity’ replaces personality as the key theoretical construct where the social forms part of who we are and these approaches seem to offer social psychologists the theoretical tools to start to appreciate how individual personality and social context are intimately connected.     

Narrative and discursive perspectives on athletic identity: Past,present, and future

ObjectivesThe dominant role-based conceptualisations of athletic identity have recently been challenged in favour of theoretical perspectives that view identity as a complex cultural construction. In the present study, we analysed empirical studies on athletic identity positioned in narrative and discursive approaches to gain an insight into the use and subsequent contribution of these approaches to knowledge production in this research topic.Design and methodA total of 23 articles, of which 18 narrative studies and five discursive studies, were identified in a systematic literature search. We used the meta-study method to analyse these studies in terms of basic assumptions, methodologies, and findings.ResultsEarly narrative studies focused on biographical disruption in career termination and/or severe injury, whereas more recent studies examined the impact of different identity narratives on athletes' well-being and career decisions. Discursive studies examined the multiple ways in which dominant understandings of gender, age, and the athletic body are (re)produced and normalised within sporting cultures and institutions and can act to constrain athletes to certain identities and practices. Both approaches highlighted that elite sport culture offers limited narrative resources or subject positions for athletes, and can endanger athletes' well-being if they are unable to comply with dominant ideals of being an athlete.ConclusionsNarrative and discursive approaches have advanced understandings of the constitutive role of sporting culture in athletic identity formation. Future research should continue exploring athletic identity in various physical cultural contexts and seek to identify alternative narratives and discourses that may enable athletes to construct more adaptive identities.     

When 2–3% really matters: The (un)importance of religiosity in psychotherapy

Previous research suggests that clients’ religious beliefs are commonly excluded from therapeutic practice. Often, this exclusion is attributed to practitioners’ lack of knowledge or appropriate skills. Such analyses, however, have little regard for the interactional aspects of the therapist/client encounter. Drawing upon work within discursive social psychology, we argue that the exclusion of religious beliefs does not reflect therapists’ lack of knowledge or awareness but can more usefully be seen as the discursive accomplishment of marginalizing clients’ beliefs. Six practising psychotherapists were interviewed about religious beliefs within the therapeutic process. Participants construct religious beliefs as important but relevant only to restricted categories of clients. They rework religious beliefs as compatible with accepted practice, or construct particular groups of clients as incompatible with the process. Training and other requirements are reformulated in terms of spiritual beliefs rather than religious beliefs. These constructions display awareness of religious beliefs while marginalizing their relevance in practice. Inclusion of clients’ religious beliefs to best effect will require more psychotherapy to engage more constructively with religion than it does at present.     

A beginner's guide to the problem-oriented first family interview

The large volume and diversity of family therapy resources can often confuse trainees who are in need of more abbreviated guidelines for managing their clinical responsibilities. This paper presents a structured outline of a problem-oriented first family interview for the family therapy supervisor and the beginning family therapist. We view the first interview as an integrated process including the important tasks preceding and following the initial family meeting. After the goals that shape the work of the first interview are described, a step-by-step guide to the twelve phases of the interview is presented: telephoning; forming hypotheses; the greeting; the social phase; identifying the problem; observing family patterns; defining goals; contracting; checklist; revising hypotheses; contacting the referral person; and gathering records. This approach to the first interview integrates a variety of structural and strategic procedures. The guide, intended for use in conjunction with close supervision, may serve as a foundation on which beginning therapists can build their unique styles.     

Feedback Informed Treatment: Evidence‐Based Practice Meets Social Construction

This article explores the challenges presented by the mandate for evidence‐based practice for family therapists who identify with the philosophical stance of social construction. The history of psychotherapy outcome research is reviewed, as are current findings that provide empirical evidence for an engaged, dialogic practice. The authors suggest that the binary between empiricism and social construction may be unhinged by understanding empiricism as a particular discursive frame (i.e., a particular way of talking, acting, and being in the world), one of many available as a way of understanding and talking about our work. Through a case vignette, the authors introduce the evidence‐based practice of Feedback Informed Treatment as an elaboration of social construction, and as an example of bridging the gap between the discursive frames of empiricism and social construction.     

Person‐centred counsellors' experiences of working with clients in crisis: A qualitative interview study

Aims: This study aims to explore and understand person‐centred therapists’ experiences and work with clients at the pivotal point of crisis. Specifically: how do person‐centred therapists experience working with clients in crisis? Do they identify differences in crisis intervention compared to non‐crisis work? What do they perceive as helpful to crisis clients? How relevant are therapists' own experiences of crisis? Method: Participants were all experienced person‐centred therapists. Qualitative, semi‐structured interviews were conducted and the data were analysed qualitatively using person‐centred/phenomenological methodology. Results: Respondents identified differences in their experiences. Typically, therapists described polarity in their experience of danger and opportunity, also heightened energy levels within themselves, perceived higher levels of engagement, faster pace of work, experiences of reaching ‘relational depth’ earlier, and the importance of assisting symbolisation of clients' experience in awareness. Clients were experienced as vulnerable, unable to access previous coping mechanisms, in a state of breakdown and disintegration, but also as wide open, having dropped their usual defences, and more available to engage in therapy and enter the process of change and potential post‐crisis growth. Discussion: The findings are discussed in relation to prevailing models of crisis intervention, person‐centred theory and theoretical developments in post‐traumatic growth in the aftermath of crisis.     

The King Is Dead; Long Live the King: Narrative Therapy and Practicing What We Preach

Narrative therapy has been associated with the assumptions of postmodernism and social constructionism; both of which support the notion that there are no truths, just points of view. Thus, narrative therapists have sought to privilege the voices of their clients in the process of delivering them from the oppressive weight of dominant, cultural grand narratives. Have they been as willing and adept at respecting the voices of other professionals, and their colleagues within the narrative camp? This question is discussed in relation to the underlying assumptions that inform narrative practice. It is concluded that narrative has perhaps unwittingly fallen prey to the human tendency to reify metaphors and make gurus of leaders.     

Refugee families in therapy: from referrals to therapeutic conversations

Refugee families referred for therapy present a wide array of problems and expectations, not always in accordance with what therapy may offer. Major differences between referring professionals, families and therapists regarding problem definitions and solutions may complicate collaboration. Interventions that may overcome these barriers and move initial interviews into a therapeutic context are described. Three patterns regarding referral process, problem presentation and expectations (here called referral contexts) are outlined: 'the relational', where families ask for psychological and interpersonal assistance, 'the unfocused', where families are referred to therapy without expressing any wish for it, and 'the fixed solution', where families seek support for solutions that are not of a therapeutic nature. The interventions described form part of a negotiation where motives and interest for therapy are explored and agreements regarding further therapy are outlined.     

The conception of audience in Perelman and Isocrates: Locating the ideal in the real

The author compares two theoretical models which develop constructs of an ideal audience. Chaim Perelman's universal audience serves a methodological function within the New Rhetoric which provides for the examination of philosophical arguments on values. Implicit within the work of Isocrates is a competing image which asserts that the ideal audience is empowered by the conditions of argument to engage the advocate in discursive praxis to construct and embody a consensus on contingency-driven value debates. The author concludes that the concept of an ideal audience will be most valuable where interest in adherence to theses is less central than attendance to relationships born in and borne by discourse. Such a view has purchase within a constitutive view of rhetorical relations which asserts that the most useful role for argument is as an invitation to engagement. The situation of argumentation within a deontological ethics requires the partnership and participation of individuals in a mutually constructed discursive praxis.David Douglas Dunlap is a Doctoral Candidate in Speech Communication at Pennsylvania State University     

Self-of-the-Therapist Work: A Balance Between Removing Restraints and Identifying Resources

The authors propose that self-of-the-therapist work is most productive when therapists and supervisors approach family of origin issues and historical life events in a balanced way and suggest that they move to an approach that ideally liberates restraints posed by self-of-the-therapist issues, while at the same time accesses resources available to therapists because of the same issues. This is a shift from the primarily restraint focus that has dominated self-of-the-therapist work. This paper also provides personal experiences of the authors, guidelines on how to create safety and balance, as well as practical examples of self-of-the-therapist exercises.     

Ambulante manualisierte Verhaltenstherapie bei Anorexia nervosa

Anorexia nervosa is a serious illness leading to high morbidity and mortality. Its treatment poses a particular challenge to psychotherapists offering outpatient treatment. Often therapists follow or work according to a treatment manual. Supervision in the treatment of anorexia nervosa patients intends to promote quality assurance as well as to foster therapists’ mental hygiene. It offers the opportunity to collect plenty of practical experiences. Some of these will be presented here to provide suggestions and support to therapists working with anorexia nervosa patients. Certain treatment modules of cognitive-behavioral therapy (CBT) such as motivation, eating behavior, case formulation and relapse prevention will be considered. Regarding the therapist-patient relationship ambivalent relation shaping and motivational interviewing will be targeted.     

Duty of Care,Safety, Normalisation and the Mental Capacity Act: A Discourse Analysis of Staff Arguments about Facilitating Choices for People with Learning Disabilities in UK Services

The benefits of having choice and control for people with learning disabilities 1 are well documented, and front‐line carers often make efforts ensuring that these are facilitated. However, despite this, government policy reports that disempowerment within learning disability services in the UK is a persistent problem. Using critical discursive psychology, 15 interviews with support workers about empowering people with learning disabilities were analysed. Interpretative repertoires about ‘duty of care’, ‘safety’ and ‘normalisation’ and discursive strategies involving ‘comparative evaluations’ were found, which opened speaker positions of granting or withholding choice, assuming responsibility for those in care and constructing service users as lacking capacity. These resources also allowed speakers to regulate the choices of service users and to normalise limited choice in ways that undermined taking up more empowering practices. The findings may explain the persistence of disempowerment within services by indicating how such discourses are deeply entrenched in service talk and are invoked to justify disempowering practices. This is discussed in view of the implications for empowerment and also current legislative frameworks such as the Mental Capacity Act. Copyright © 2014 John Wiley & Sons, Ltd.     

Back in the mirrored room: the enduring relevance of discursive practice

This article seeks to re‐engage a conversation regarding the importance of acknowledging the discursive content of the therapeutic process. Hare‐Mustin's (1994) article argued that psychotherapy is involved in the generation of values and norms, and thus requires ethical sensibilities. Her analysis recognized how particular socio‐cultural forces go unnoticed and suggested that unless therapists recognize their participation in discursive practices, they may unwittingly collude with and reinforce harmful cultural practices. The goal of this article is to revisit the ‘mirrored room’ so that family therapists can more deliberately evaluate their participation in cultural practices that impact on their work with clients. This article begins with a review of contemporary efforts to grapple with the issues Hare‐Mustin presented, and maintains that even contemporary approaches that assert a commitment to postmodern understandings remain incomplete without an analysis of discourse. The article then outlines the conceptual tools within discursive practice that advance the initial motivation of these contemporary efforts.     

Distinguishing Between Conceptualizations of Attachment: Clinical Implications in Marriage and Family Therapy

Authors described four distinct conceptualizations of the construct of attachment and identified clinical implications associated with each. Three of the conceptualizations, which are influenced by the work of Bowlby and Ainsworth, seem to have some empirical support; these conceptualizations are compatible with systemic and social constructionist approaches to family therapy. The other conceptualization— Reactive Attachment Disorder (RAD)—contradicts the extensive body of literature associated with the Bowlby/Ainsworth traditions and tends to pathologize children. Therefore, family therapists interested in attachment are encouraged to maintain conceptual clarity in their clinical work and are further encouraged to rely on clinical conceptualizations and interventions that are consistent with the work of Bowlby and Ainsworth.     

The universe of our concerns: the human as person in the praxis of analysis

Since its inception, psychoanalysts and analytical psychologists have used the reductionistic methods of science to explain both human development and analytic practice. The most recent iteration of this tendency uses attachment as the explanatory principle. This disposition has created theories that understand the human solely as an organism. While this is a satisfactory way to view human development, it is not appropriate for the practice of analysis. In this context, the human must be viewed as a person that is explicable in his/her own terms. Interpretation based on reductionism eliminates personhood. Humans appear as persons in 'the feeling of what happens' or of 'being there', and, on the basis of this experience, develop stories in which their personhood evolves. The psychoanalytic, philosophical and neuro-scientific basis for this view of the human as person is discussed, and its relevance for analytic practice is considered.     

The Debate: A Strategic Technique

This paper describes the work of a strategic team that came out from behind the one-way mirror. A debate among the team is enacted before the family as a strategy for change. The case of a family that refused to provide information illustrates an application of this method. The debate among the therapists represents a dilemma that is a strategically constructed isomorph of the family situation. From this position, therapists have the option of changing levels between themselves and the family, asking the family to help solve the therapists' dilemma so that they in turn can be free to help the family. The combination of the debate and the change of levels between the therapists and the family creates a therapeutic neutrality for the family. From their meta position, they observe the therapists' struggle to solve the family's problem, which is re-presented as a problem among the therapists. This perspective offers the family the choice of more adaptive solutions to their own dilemma.     

Hunger, eating, and ill health

Humans and other warm-blooded animals living with continuous access to a variety of good-tasting foods tend to eat too much and suffer ill health as a result--a finding that is incompatible with the widely held view that hunger and eating are compensatory processes that function to maintain the body's energy resources at a set point. The authors argue that because of the scarcity and unpredictability of food in nature, humans and other animals have evolved to eat to their physiological limits when food is readily available, so that excess energy can be stored in the body as a buffer against future food shortages. The discrepancy between the environment in which the hunger and eating system evolved and the food-replete environments in which many people now live has led to the current problem of overconsumption existing in many countries. This evolutionary perspective has implications for understanding the etiology of anorexia nervosa.