Constructivism in Psychotherapy - part III, IV

Robert A. Neimeyer , Ph.D., é Professor e Director of Psychotherapy Research no Departamento de Psicologia da Universidade de Memphis, onde mantém também prática clínica. Esta entrevista teve lugar a 18 de Outubro de 2010 em Lisboa, com contributos de M. Gonçalves. Está segmentada em 6 blocos temáticos - que perfazem cerca de 50 minutos-, e um sétimo segmento final de abertura aos participantes. São abordados os seguintes temas:
Part I - Constructivist Psychotherapies distinctive features and evolution;
Part II -  the empirically supported treatments and manuals;
Part III-  psychotherapy schools and approaches;
Part IV -  the Integrationist movement and Psychotherapy evolution;
Part V - the Constructivist Grief Therapy approach;
Part VI - the training in psychotherapy
As questões dos participantes,  Part VII - Elaboration o loss, Buddhism, being a psychotherapist, compassion, everyday losses.

Transcrição de A. Ganho e T. Alfama. Tradução de A. Santos. Produção e Edição Video e Audio de Vasco Henriques.

Part III-  psychotherapy schools and approaches;

A.H.: Changing the topic from manuals to models and schools role in our education we can see in your clinical writings a strong integration of Coherence Therapy concepts and techniques. How do you see this model – Coherence Therapy – and it’s visibility in the USA?
 
R.N.: It’s almost invisible, which is tragic. Bruce Ecker, the principal contributor of course to that tradition publishes beautifully but infrequently. And as such it does not have the level of prominence that it deserves. I find it to be an elegant and intelligent model and probably one of the purest instantiations in therapeutic method of a constructivist orientation. I think that it is itself deeply coherent with the core of constructivist work. And I think it is clinically elegant and parsimonious while also conferring on the client the status that he or she appropriately has of being an agent responsible for his or her existential and even symptomatic position and capable in a moment of changing that. And so I strongly support the broader diffusion of this perspective and it has certainly deepened and clarified my own practices as a therapist.                                            
 
A.H.: Psychotherapy schools have been – I don’t know if you think like that – have been solid anchors for the maturing therapists, for trainee therapists? But also obstacles to a so much needed epistemic openness and flexibility. Do you think they are still necessary? Schools are still necessary for our development as therapists?
 
R.N.: Yes, because as human beings we are limited and we organize our lives around attachment to people, places, projects, possessions that matter to us. Our schools give us a focus for that attachment to a given tradition and the people who represent that tradition. I think in this way they make a useful contribution but we need to always remember not to take our models too seriously, to regard them as humble approximations to a much more complex phenomenon that is human life. And as such I don’t encourage people to hold on to their models with white knuckles or to defend them against all opponents but instead to use them as a basis for dialogue around matters of common concern with practitioners of other perspectives. And as we engage in deep dialogue in this way then we find that our models naturally begin to flow and to change and this is the nature of dialogic interaction, whether it is with other models or with other human beings. And of course in the case of psychotherapy we are speaking about the people who are exponents of those models. So I think we are far better of building bridges rather than walls in relation to people who occupy other perspectives.
 
A.H.: How do you think schools are evolving nowadays in this perspective? Do you think they are moving and improving in an integrationist way and direction?
 
R.N.: I think many of them are, in the sense that as I speak to practitioners of different schools of Family Therapy – there is a blending of traditions – so the work of the Milano School for example would now be blended with more structural or systemic or strategic approaches. I think within the psychodynamic field one has a very rich interchange – you no longer have people divided so clearly into Kohutians and Kembergians and, you know, people who have an object relations orientation – there’s much more interchange within related families of models. There are still less interchange across models and then in the cognitive-behavioural area - where theoretical sophistication has always been at a low level compared to other approaches - there is a tendency to appropriate techniques from other approaches and then simply relabel them as cognitive-behavioural. So de facto it is an integrative tradition – sort of.  But it’s almost ironically unconsciously integrative in the sense that it does not seriously engage and tend to practice dialogue with the theoretical premises about their models as extensively as it might. 
 
A.H.: They focus mainly in the techniques…
 
R.N.: I think yes. I think that it is… The focus is at a more concrete level overall and this is also registered in a kind of movement toward technical integration that seems to be preferred within these orientations. But overall I think across the field of psychotherapy interchange is more common than it was fifteen years ago and I think that that’s a healthy thing.  
 
A.H.: Yes. Some authors see a future for schools and models to disappear and give place to fundamental guiding principles to work with specific problems and fundamental processes to work with emotion, cognition, behaviour and motivation. Do you believe in this trend and development in the future and how far are you from this point?
 
R.N.: My orientation in general is to embrace developments of conflicting and contrasting kinds because culture is sufficiently broad – even the culture of psychology or psychotherapy - is sufficiently broad that it can afford to develop along different lines. And so I would happily agree with people like Les Greenberg who might be seeking basic processes of change and the markers that indicate the appropriateness of particular therapeutic strategy in the context of therapy. I would happily embrace the work that is informed by contemporary neuroscience that suggests the role of affect, affect regulation, attachment schemas and so on, which can be seen to operate at the level of functional MRI’s, and the influence of the new brain sciences in this way for understanding human change in the context of therapy.  And I also see a role for continuing refinement and application of traditional models of therapy. So, I think that there is room in this field for coexistence and a kind of collaboration and interchange among people who are pursuing different  routes  to the development of therapy.

Part IV -  the Integrationist movement and Psychotherapy evolution;

A.H.: Ok. Changing the topic into the integrationist movement, could you tell us about your perspective on what integration should be? You have suggested that theoretical progressive integration – you say and I’m quoating you – “that at the heart of this perspective is a concern with epistemological criteria for integration and the ideal candidate approaches for psychotherapy integration would be different models of therapy that show a strong convergence at core levels but considerable diversity at strategic levels”.
 
R.N.: Well, I would place that assertion of mine both in a place of my own development that was some time ago - almost twenty years ago – and I would also defend it as an approach among other possibilities. I wouldn’t see it is a pre-emptive possibility, the only way that integration should be pursuit. It is to say that at theoretical and practical levels the borrowing from different perspectives can not be what we would call in English hodgepodge that is a kind of random integration. When we see this done, we see therapy is just become esthetical ugly and practically confusing to the participants. So if I’m eliciting the deep narrative, the structure of the deep context of your life and your core meanings and believes and then I take the advantage afforded by that deep disclosure – maybe of your spiritual believes and so on – in order to chastise you and dispute them empirically and so on, then one has shifted paradigms incoherently right? - From a kind of constructivist appreciation of your uniqueness to a kind of hegemonic stance of authority. And I think that those kinds of shifts where you would might move from a deep narrative procedure to a thought record that disputes its premises that would be an example of something that I would regard as an incoherent kind of integration. On the other hand there are many coherent ones, so that one might be working in a deep narrative way with an individual but embedding that person the context of his or her family, and understanding then - maybe through the use of Milan style circular questions - the way in which the positions of others on the story you’re telling may differ from your own and we might ask whose story is most like Anibal’s? Whose‘s asleast like his? And I would see this as a coherent integration because it respects the same premises about the - in some way - the personal priority of meaning. But also then looks at them as something that would be negotiated in social discourse, particularly within families or communities. 
 
A.H.: Would you say that this progressive integration it is somehow happening around the models?
 
R.N: Oh, who knows? I’ll leave that to wiser heads to judge than mine.
 
A.H.: Yes. In the recent years was there any positive signs in the field of psychotherapy that you would like to point out and negative ones?
 
R.N.: Well, let’s start with the bad news. I do think that - not only in US but also increasingly in Europe and it’s beginning to find expression, as well in eastern countries - we do have more and more and more domination of the training basis, at least in university settings and certainly at the research literature, more and more domination by a single perspective or one that has minor variations – and that is a cognitive-behavioural one with the intolerance that it often shows for other perspectives. And I think that that’s an unfortunate thing. I think that in the same way that we should be protecting biodiversity on the planet, on the same way that we should be respecting diversity among peoples and believes and the same way we want to support many forms of artistic expression and literature, in the same way that we want to support competing scientific theories that are pursuing similar objectives – in this way too we really should be looking to support novelty and diversity in psychotherapy and psychotherapy research. And I do fear that that goal is being subordinated to a kind of administrative role based orientation which is really predicated on economic concerns more than psychological ones, and I regret that. There are also, I think, many positive developments. There are lots of interesting approaches to therapy that continue to be developed and refined and I think that increasingly novel approaches to therapy are being tested with respect to identifiable forms of human distress and pain and found to make a useful contribution to those. I think that that’s the very salutary positive development.