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.     

Foucault and the turn to narrative therapy

Narrative therapy evolved in the family therapy arena in the late 1980s in Australia and New Zealand. Since then it has been extended to other counselling settings and a burgeoning literature has arisen around it. It is situated in the social constructionist, postmodern, poststructuralist discourses that challenge and force a re-evaluation of humanism and traditional psychological and counselling discourses. Its pioneering authors, White and Epston, state clearly that, amongst others, they have been influenced by the work of the French theorist Michel Foucault to not only question the dominant assumptions underlying humanism and psychology, but also to address issues of meaning, subjectivity, power and ethics. This paper briefly outlines some features of narrative therapy, examines the Foucauldian themes in White and Epston's theory, and explores narrative therapy's poststructuralist challenge to humanist assumptions in 'therapy culture'.     

Dual realities – The search for meaning: Psychodynamic therapy with physically ill people

Abstract

We summarize Kohut's (1971) bi-polar self which enables counsellors to understand and treat narcissistic behaviours and narcissistic personality disorders in a psychoanalytic framework. After Patton and Meara (1992), we describe Kohut's formulations regarding self-development and disorders of self and how such formulations inform critical components of psychoanalytic counselling with particular emphasis on the explicit and implicit strategies and characteristics the counsellor brings to the process. Finally, we suggest that a promising arena for future theorizing and applications of Kohut's ideas is consultation with parents, teachers and other community leaders to help prevent or remedy psychological self-injuries with systemic interventions outside short-term counselling or long-term therapy.

We have suggested that Kohut's self psychology is a good vehicle for understanding what brings a client to counselling: namely, disorders of the self or self-injury. We review strategies and ‘ways of being’ a counsellor must bring to and offer in the counselling encounter if the work is to succeed. We also examine implicit qualities (beyond the achievement of a mature bipolar self) we believe a counsellor or any facilitator must have if counselling or other helping relationships are to be effective. We purpose further conversations and empirical analyses which specifically and conceptually link critical components of psychoanalytic counselling to self psychology and to essential counsellor traits or virtues that seem intrinsic to good counselling practice.     

Everything you always wanted to know about therapy (but were afraid to ask): Social,political, economic and clinical fragments of a critical psychotherapy

Three seemingly consensual propositions concerning psychotherapy and counselling are examined critically. All turn out to be unreliable, tendentious and even damaging: (i) Psychotherapy and counselling can be free and independent professions provided therapists, acting together, fight for them to be that way. (ii) Psychotherapy and counselling are private and personal activities, operating in the realms of feelings and emotions – the psyche, the unconscious, affects rooted in the body. Above all other factors, the single most important thing is the therapy relationship between two people. (iii) Psychotherapy and counselling, and psychotherapy are vocations, not jobs. Therapists are not only motivated by money. In developing his critiques of these propositions, the author utilizes social, political and economic perspectives. The author reviews new clinical thinking on the active role of the client in therapeutic process and suggests that a turn to the legendary figure of the Trickster might be of benefit to the field. The author locates his arguments in his experience of the politics and practices of psychotherapy and counselling, and engages in self-criticism.     

Existential Social Theory After the Poststructuralist and Communication Turns

Thomas Flynn's work on Sartre and Foucault, the first of a two-volume project, offers a unique opportunity for examining an existential theory of history. It occasions rethinking existential-social categories from the vantage point of the poststructuralist turn. And it contributes to developing existential variants of critical theory. The following questions guide me in each of the three above areas. First, how is human history intelligible, given not only our finite sense of ourselves but also claims that we have reached the end of history? Second, with the poststructuralist eclipse of dialectics, can we render existential categories in social terms and vice versa? Third, critics decry grand theorizing even in fallibilist reason, e.g., of Habermas, while others are worried by the normative deficits of poststructuralist nominalism, e.g., of Foucault. Can existential variants of critical social theory, anticipated before Sartre by Marcuse, split the difference?     

The Manifolds of Violences

In this essay, Houle focuses in on the ways in which a Foucauldian‐framed account of violence, such as the one Gail Mason offers in Spectacles of Violence, rattles liberal (theoretical and ‘common‐sensual’) understandings of culpability and lawfulness. Mason's analysis dares to suggest that violence is constitutive, not simply destructive of selves, of lives. Asking after the ways in which that constitution is asymmetrical in events of violence, Houle reintroduce some cautions and concerns about drawing from a poststructuralist perspective. This, in turn, raises the question as to which ontology of the self such a rebalancing requires. The essays ends by making use of Mason's own distinction between our selves as ‘who’ and ‘what,’ to give a modified reading of the ways these aspects of selfhood are constituted or made possible in events of violence, which does not fall back upon the liberal conception of the self.     

Does client self‐booking reduce ‘did not attends’ (DNAs) in a counselling service?

An important problem for our counselling service is the high number of clients who ‘did not attend’ (DNA) for their booked appointment. This paper aims to describe how we tackled this problem within our counselling service by using a Plan‐Do‐Study‐Act (PDSA) cycle (Langley, Nolan Norman and Provost, 1996). The results found that by devising a system whereby clients could self‐book their appointments we were able to reduce the DNA rate for first appointments from 31.70% to 2%. This has useful time and financial implications. We would expect that the self‐booking approach we have outlined here is adaptable for other counselling services.     

The aims of HIV/AIDS counselling revisited

This paper investigates the present WHO/GPA counselling aims which are based on a disease-centred approach. It argues that as the parameters of the pandemic have changed the present counselling aims are no longer as relevant. These aims need to be revised in the light of recent developments and should be based upon a person-centred approach. The new counselling aims concentrate upon improving an individual's self concept and self esteem and recommend that People With AIDS continue to participate in society to make a valid contribution and maximize their individual satisfaction.     

The concept of culture in the contexts and practices of professional counselling: A constructivist perspective

In this paper we first describe two approaches to the concept of culture as they relate to counselling: the first approach emphasizes the organizational culture of the institution where the counsellor works; the second - the multicultural approach - calls for the recognition of the variety of ethnic cultural backgrounds of those involved in the counselling situation. Then, we present recent developments in the understanding of culture within constructivist perspectives. Last, we suggest a new orientation for counselling training, that of the professional counsellor as a cultural agent, one attentive to context and practices in all their complexities.     

Asklepian Dreaming and the Spirit of Transformational Healing: Linking the Placebo Response to Therapeutic Uses of Self

Asklepian medicine – as an archetype of healing – was underpinned by therapeutic uses of self, which, if understood, could be beneficial to modern healthcare. It is being proposed in this article that therapeutic uses of self from instrumental, authentic and transpersonal perspectives could support the process of endogenous healing. Such therapeutic uses of self could play a pivotal role in activating and enhancing the potential for placebo responses, with spiritual significance.     

The rise in demand for counselling

Explanations for the rise in demand for counselling are discussed. These include dissatisfaction with clinical psychology, the loss of social and personal supports, New Age aspirations for personal development, and insuficient numbers of clinical psychologists. Evidence is presented against the views that there has been a recent loss of social or personal supports, and that personal-development aspirations through unorthodox routes are a new phenomenon. The apparent rise in demand for counselling is explained rather as a rise in demand for counselling training, by would-be practitioners. This demand in turn is fuelled by developments in public-sector employent, leading employees to seek extra qualifications to enhance their job security. Nevertheless, the relatively weak appeal of clinical psychology, together with its low public visibility and its weak licensing power, encourage the continual emergence of alternative therapies.     

Employing autobiographical memory perspective to influence self‐congruence and brand preference

This paper advances our understanding of consumer behavior by examining the influence of autobiographical memory perspective on consumer's self‐congruence. While extant research has primarily restricted itself to the consequences of self‐congruence, this work focuses on an antecedent, by examining the psychological processes associated with the consumer's autobiographical memory perspective and the resulting impact on self‐congruence. Through three experiments, we demonstrate that visualizing autobiographical memories from a first‐person versus a third‐person perspective impacts consumers' self‐brand congruence differently under varied circumstances. Specifically, differing degrees of self‐brand congruence are experienced when consumers focus on differences (vs. similarities) between their present and recalled selves, combined with distinct autobiographical memory perspectives. The autobiographical memory perspective is identified as a key determinant of consumers' perceived change in self‐image, which, in turn, has a cascading effect on their self‐brand congruence. Thus, consumers' perceived change in self‐image is identified as the mechanism underlying the main effect. Furthermore, as an important component of self‐image, this research determines and examines a moderating influence of self‐esteem in the relationship between autobiographical memory perspective and self‐congruence. Collectively, these results facilitate our understanding of the autobiographical memory perspective as an antecedent of consumer's self‐congruence, with implications for nostalgia advertising and retro branding.     

Considering poststructuralist discursive community psychology

Although critical community psychology (CCP) has embraced several discursive paradigms (e.g., critical discourse analysis, discursive psychology, and Foucauldian discourse analysis), there remains little CCP work that attempts to conceive of CCP through a poststructuralist discursive lens, a lens that extends beyond, but certainly does not ignore, the analysis of data. In this study, we consider what we are calling poststructuralist discursive community psychology through a synthesis of poststructuralist discourse theory and CCP. Such a psychology is one that conceives of social phenomena, and indeed conceives of itself, through a poststructuralist understanding of discourse. We offer two pathways through which to consider poststructuralist discursive community psychology: re-envisioning community and discursive consciousness-raising. We conclude by considering some of the theoretical limitations of our discussion, as well as the areas that future work into poststructuralist discursive community psychology may enter into.     

An Animal Just Like Me: The Importance of Preserving the Identities of Companion‐Animal Owners in Disaster Contexts

The widespread tendency of modern‐day pet owners to self‐identify with their companion animals psychologically, symbolically and relationally demonstrates how the constructed identities of animal and owner are strongly linked. This becomes particularly apparent during natural disasters. In this review, the new concept of the pet‐owning self is discussed in relation to three self‐psychology perspectives: self‐extension, symbolic interactionism and selfobject relations. We purposefully depart from the realm of attachment theory to argue that these three epistemological approaches to self‐identity, although related, warrant closer examination. Although we discuss them in relation to disaster contexts, the concept of the pet‐owning self remains widely applicable. We argue for the importance of acknowledging the powerful intersubjectivity inherent to pet keeping, the inseparability of perceived pet identity from owners' experiences of the self and that preserving the cohesion of the two is an essential consideration for owners' psychological wellbeing when managing the integrated pet/owner in the face of risks posed by disaster and other hazards. Future research opportunities and implications are then discussed in the context of social identity theory.     

Predictors of Diabetes Self‐care,Metabolic Control,and Mental Health in Youth with Type 1 Diabetes

The purpose of this study was to explore the psychosocial predictors of diabetes self‐care (adherence to care regimes), metabolic control (glycated haemoglobin), and mental health among rural‐ and urban‐dwelling youth with type 1 diabetes. One hundred and twenty three adolescents/young adults (aged 13?25 years, mean = 16 years, standard deviation = 3.8 years) with type 1 diabetes, 50 males and 73 females, completed questionnaires reporting on diabetes self‐care, metabolic control, mental health (negative affect, quality of life), risk‐taking behaviours and attitudes, diabetes self‐efficacy, community engagement, and perceived social support. No rural/urban differences were detected on key predictors or outcome variables. Structural equation modelling revealed that high diabetes self‐efficacy, lower risk behaviour, and more conservative attitudes to risk taking predicted better diabetes self‐care, which in turn predicted better metabolic control and mental health. Social support and engagement in community activities did not influence diabetes self‐care. The study has significance because both diabetes self‐efficacy and propensity towards risk behaviour are potential targets for educational and counselling interventions designed to improve diabetes self‐care regimes and resultant metabolic and mental health outcomes.     

On integrity

This paper argues that, rather than statutory registration, it is the personal integrity of the individual practitioner that will best safeguard the interest of the client and ultimately the image and reputation of the counselling/psychotherapy profession within society. An attempt is made to define integrity as an absolute moral component of the personality and to consider its significance to the therapeutic relationship. Trust, too, is considered as a vital factor in this relationship. As well as the integrity of the individual practitioner, the integrity of the psychotherapy profession as a whole is considered with particular regard to its considerable reliance on the production of theory for its sense of self worth, as opposed to its efficacy as a therapeutic enterprise.     

The good,the bad and the uncertainty: Trainees' perceptions of the personal development group

Background: Views about the purpose and role of personal development groups (PD group) in the counsellor training process are varied. Some argue they enhance self‐awareness, self‐exploration, the ability to be congruent and, ultimately, that they make for better practitioners. Others argue there is no clear evidence for such benefits and that they can actually be damaging to trainees. Aims: This study aimed to explore the beliefs of 25 trainees enrolled on counselling diploma or counselling psychology doctoral courses. It looked in particular at their perceptions of the purpose of PD groups and their expectations regarding support, difficulties and the scope of their participation. Method: Data was collected using open‐ended questions in an anonymous survey and was subjected to a thematic analysis. Results: Trainees appeared to hold mixed – and sometimes conflicting – views about the PD group. For some it was a positive endeavour that facilitated learning about self and clients, and helped in the processes of developing counselling skills and keeping the training group healthy. For others it was a feared space, which could elicit negative emotional experiences, and impact negatively on both learning outside of the PD group and the health of the group itself. Still others were unclear about its purpose. Hope/idealisation (of the process, the facilitator and course tutors) were also evident in the trainees' responses. Implications: Implications of these findings for counselling training are discussed.