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Content uploaded by Edgardo Morales
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All content in this area was uploaded by Edgardo Morales on Jul 01, 2015
Content may be subject to copyright.
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Therapeutic Heresies:
A Constructionist-Relational Approach to Psychotherapy
Dr. Edgardo Morales Arandes
*
Department of Psychology
University of Puerto Rico
Relational constructionism begins with a simple but important idea: everything
we consider real, all the truths that we cherish and the values we hold are constructed in
and through the web of relationships that we participate in. When applying this idea to
psychotherapy, we are invited to re-imagine and question its practices and traditions,
particularly, those that have operated as unexamined truths or as a foundational logic in
the discipline. This approach to psychotherapy may be considered a heresy when
compared to traditional theories and models, that through their rigid standards and
orthodoxies, and claims to objectivity and knowledge, have imposed an institutional
order constraining the imaginative possibilities of therapeutic practice.
In this paper, I wish to explore the ways through which relational constructionism
can help to release our imagination and creativity as psychotherapists. In it, I will make
reference to the controversies, tensions, and uncertainty that are present within our
practice and within our discourses. I will also suggest a view of psychotherapy that sees
therapist and client, as active co-participants in constructing the realities that
emerge during the psychotherapeutic process. This approach stresses the importance of
using conversational resources such as humor, curiosity, listening, metaphor, storytelling
and improvisation, as a way to explore a client‟s narrative and generate new possibilities
for meaning and action in his or her life.
Several of these conversational resources will also be included in the “telling” of
my story of relational constructionism and psychotherapy. I include personal narratives,
reflections and conversations with others, as part of my tale. Hopefully, this will enable a
*
The author is Assistant Professor at the Psychology Department of the University of Puerto
Rico, Río Piedras Campus. His email address is: emora_pr@hotmail.com.
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dialogue with the reader that may enrich and deepen his or her understanding of the ideas
that will be discussed. I begin with a personal story …
Discarding Flowers
More than thirty years ago, I began my clinical practice as a “psychosocial
technician” in a mental health center in Puerto Rico, where I was expected to lead group,
couple and individual therapy. I had recently graduated with a bachelor‟s degree in
psychology and had few other qualifications to perform psychotherapy, other than
general readings in psychology and my own experiences as a client.
I met my first client filled with anticipation and anxiety. She was a 30-year-old
woman who entered my office crying, anxious and concerned about the future of her
marriage. She was convinced that her husband no longer loved her and came to therapy
in order to prepare herself emotionally for what she believed would be the eventual break
up of her relationship.
She told me she had been married for over a year and that she was deeply in love
with her husband. She was distraught because his behavior during the last several
months appeared to indicate that he was disinterested in their marriage. This, according
to her, contrasted with his actions during the months that immediately followed their
wedding. During that time, he seemed to be deeply in love with her. He called her at
work several times a day and sent her a bouquet of flowers three or four times a week.
As she sobbed, she sadly stated that “he was now a changed person”. “His calls”
she said, “had become less frequent” and now he called her “only once a day”. She
paused and spoke sadly as her eyes swelled with tears, “Now, I only receive flowers once
a week.” I asked her, if she had shared her concerns with her husband. She answered
“yes”, and indicated that when confronted with her doubts, he insisted that he loved her
as much as before. His strong denial, she claimed, just served to increase her distrust.
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I proceeded to ask her general questions about her relationship. She insisted that
they had no major conflicts and until recently, she had enjoyed the time she spent with
her husband, as well as their sexual relationship. She reiterated, however, that because of
the change in his behavior, she was afraid that something terrible was going to happen to
their marriage, and that this made her feel strange and distant from him.
Listening to her story, I was somewhat perplexed and unsure on how to proceed.
Looking for some kind of opening, I decided to ask her about her life and work
environment. Her sobbing decreased as she described her job as a secretary and how
much she enjoyed it. She also spoke of her many female friends at work. I asked her if
they were married and if they felt loved by their husbands. She answered in the
affirmative, and added that she knew this, because the quality of their relationships with
their husbands had been a topic of conversation during her first months of marriage.
As I heard this last comment, I heard the voice of my own therapist resonating
within with the questions he usually asked when I shared a particular story. Then,
something changed inside me, I paused for a second and attempting to appear confused
and perplexed asked her, “And what do they do with all the flowers in your office?” My
client was momentarily stunned by my question and answered, “I don‟t understand.
What do you mean?” I responded, “Well, if your co-workers have wonderful
relationships with their husbands, then I suppose your office must be flooded by
telephone calls and the flowers that they send daily to their wives. I imagine that there‟s
a serious problem with organizing and discarding them. It must be a full blown
operation, and I thought that in your office someone had figured out some novel solution
for this. I was just wondering how they did it.” For a moment, she seemed more
perplexed than before. Then a slight smile appeared on her face before she asked me,
“Are you kidding? “I answered, “No, I‟m very serious about this. I‟ve thought about
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working as an organizational consultant and thought that the solution might be helpful to
me in the future”. She stared at me for a second and then began laughing. Then, she asked
me, “Are you trying to tell me that I‟m worrying needlessly…. that my husband, as well
as other husbands, has his own way of expressing his love?” To which I answered,
“Well, I don‟t know if that‟s the case, but what I think really doesn‟t matter; what matters
is what you believe. What do you think?”
From that moment on, the tempo of the conversation changed. We began to
reflect together on the events and meanings of her initial story. We explored whether
there were any other reasons that would lead her to worry about her relationship with her
husband and if there were conversations with him that she needed to engage in. We
talked about her dreams for her relationship, her professional goals, and the importance
of communicating and affirming herself in her life. When the session was finished, she
thanked me and told me that she would contact me if necessary. I never saw her again,
but a couple of months later I received a letter thanking me for my services.
Through the years I have shared this story with students and colleagues. The
responses have been varied. Some have been surprised by the ingenuity and the luck of a
novice therapist. Others have been more critical. They‟ve questioned a therapeutic
strategy that did not diagnose the disorder that the client suffered. This, they‟ve
reminded me, should have been one of my priorities. Several colleagues of a more
cognitive persuasion have argued that I should have been more systematic in my
approach, helping her to identify her cognitive distortions and teaching her to substitute
them with more rational ways of thinking. Others have thought that my approach was
too superficial. Problems like the one she portrayed they‟ve claimed, are often indicative
of a complex disorder. They‟ve suggested that her obsessive preoccupation with the loss
of her husband‟s love functioned as a symbolic representation of an unresolved psychic
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conflict with her father. They pointed out that what I did probably just helped to suppress
a symptom that would reappear in the future, perhaps in a more virulent fashion, since
what caused it in the first place had not been resolved.
Each advice that I heard, if applied, would have taken my conversation with her in
a totally different direction. It would have produced different questions and
interpretations. A new story would have probably emerged. What would have been
considered important, significant, or problematic, would have been defined differently
according to the personal and theoretical framework which I would have utilized.
This anecdote and the responses to it, points to the multiple ways that therapist
and client participate in the constructions of the “realities” they encounter in
psychotherapy. It illustrates how what we as therapists listen and seem to “discover” in
psychotherapy are not de-contextualized realities or stories. We co-create them with our
clients through the way our conversations, body language, dramatic and emotional
expressions, questions, affirmations, and silences construct a conversational “dance”
through which a client‟s story is told and heard.
Relational Constructionism
This view of psychotherapy as a place where stories are co-created is founded on
a relational and constructionist concept of social reality. This approach stresses that
meaning doesn‟t lie inside or outside the individual, but rather develops in and through
our relationships with others. It affirms that what we know, and our ethics and morals are
constructed through our participation in the social world and the communities and
traditions to which we belong. It sees human beings as active agents who construct the
social realities in which they participate. These constructed realities guide and provide
meaning to one‟s own actions and the actions of others‟ (Botella, 2006; Gergen, 2007;
Hosking, D., 2007).
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From the perspective of relational constructionism, stories and narratives are the
means used by human beings to generate meaning. They serve to construct order in a
changing and sometimes chaotic world where a clear course of action is not always
evident. Stories and narratives give substance to our experiences, placing and organizing
them in temporal space. They help us to explain events, to relate one experience to
another, while generating a sense of coherence and continuity in our lives. (Cotter, Asher,
Levin & Caplan, 2004; Botella, 2006).
Our stories are constantly evolving and changing according to the ongoing
experiences and relationships in our life. There is not one story or narrative that defines
us, or that is permanently static and fixed in time (Cottor et al, 2004). They are not
products of isolated selves but instead, are social creations that are generated through the
relational networks that we maintain throughout our lives. Each story requires a narrator
and an audience that listens and responds to it. The dynamic relationship between
narrator, narrative, and audience transforms a particular narrative and converts it into a
co-created product and a form of relationship through which we generate meaning and
elaborate a particular social identity (McLeod, 1997).
The “self” appears as another character in the collection of stories which we
narrate. It emerges as a construction that is produced and reproduced in the context of
the multiple relationships in which we engage. For the perspective of relational
constructionism there is no such thing as a fixed self, or a particular essence that defines
the “individual self”. Instead, the “self” is seen as a “community of selves” that emerges
thorough our relationship and participation in different social contexts. Therefore, it
can‟t be said that we speak from one identity and through one voice. “We are all
comprised of various voices that reflect our participation in different social and relational
contexts, voices that; if not identical do configure a polyphony that contributes to the
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final product” (Botella, 2006, p. 30). As poly-vocal beings, we have the capacity to
speak with different voices, from multiple perspectives and points of views.
These assumptions about the self are not proclaimed as a new truth. Doing so
would be contrary to the ideas held by relational constructionism, since it would
presuppose that an objective reality exists that can be grasped and understood by a set of
concepts and practices that operate independently of their historical and social contexts.
Instead, relational constructionism assumes that when a new truth is proclaimed and a
given course of action is seen as morally correct, it reflects a particular cultural tradition
in the context of a specific form of relationship or way of life (Gergen , 2007).
Assuming that reality is relationally constructed does not preclude advocating
values and positions or proposing rules and guidelines to coordinate actions and regulate
human activity. When engaging others we need to speak, choose and act to satisfy
shared and personal interests, as well as address controversies, dilemmas, and conflicts
that may part of social discourse and interaction. Our actions, however, can be tempered
by the understanding that any value or declared truth is situated in a particular historical
and communal context and therefore, there is no ideology, tradition, or way of knowing
that represents a universal truth or has an intrinsic normative power.
This stance promotes what Gergen and Gergen (2004) have called a radical
pluralism, an openness in the social discourse to the multiple forms in which we can
value or attribute meaning. Radical pluralism frees us from the need to decide which
tradition, ideology, or ethical or moral proposal represents the “truth”. It favors social
practices based on dialogue and respect for diversity. It also promotes the emergence of
discordant voices, and the curiosity to explore and understand the role that these play in
the communities and traditions from which they emerge.
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Relational constructionism invites us to pragmatically and critically reflect on our
everyday lives, on the values we hold and the actions we take. In a constructed world,
any action or belief is seen as only one way, amongst many, of engaging or valuing social
reality. Therefore, rather than evaluating whether a specific argument or pronouncement
is true (that is, if it is a precise representation of reality) it favors examining the
implications of what is being advocated. We can ask ourselves, for example, what
practices or bodies of knowledge are privileged and which are being suppressed or
marginalized by the “truth” I‟m being asked to hold? We can question what traditions
are honored and which are being discarded in what is being promoted by what is being
said or by what is being written? We can also reflect on the world that is being created
by a particular social discourse and whether it is the type of world we would want to live
in. (Gergen and Gergen, 2004)
This stance towards living promotes a type of sensibility and social practice that
sharpens our critical awareness and generates new possibilities for dialogue and social
coexistence. It provides a generative framework for exploring and enriching our capacity
to understand and for action in the midst of a poly-vocal world . (Gergen and Gergen,
2004; Botella, 2006.)
Psychotherapy and Relational Constructionism
Relational constructionism is not a model for doing psychotherapy instead.
Instead, it proposes a stance for engaging psychotherapy. It invites us to rethink and
reconsider the practice and traditions of psychotherapy, as well as the ways through
which the realities that clients and patients experience are co-constructed during the
psychotherapeutic encounter. In rethinking psychotherapy, it also seeks to challenge
taken for granted practices that may serve as unquestioned blinders that restrict the
capacity of its participants to perform sensitive, spontaneous and/or regenerative action.
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For example, a core component of modern psychotherapy is the practice of
diagnosis. Diagnosis has been seen as a necessary step for understanding and explaining
a client‟s problems and for designing and initiating treatment plans. Its terminology has
been sanctioned by the managed care system and is required for billing. As a social
practice, it positions the therapist as an expert observer, tasked with questioning and
examining a client (who is assumed to be in some way deficient and needs help), in order
to comply with a pre-established agenda of locating the individual‟s dysfunctional
condition within a set of pre-established categories.
Diagnosis may comfort a particular client because it may provide him or her with
the hope that by naming a clinical condition, a problem has been identified and a
treatment leading to a solution can be implemented. However, from a relational
constructionist perspective there is much to challenge and question regarding the
unexamined assumptions of its practice, as well as the view that it purports of
psychotherapy and the psychotherapeutic relationship.
Diagnosis is part of the modernist tradition in psychotherapy. It assumes that
there is a truth value in the assertions of those that are thought of as objective observers.
In its attempt to mimic the medical sciences, it holds that human action and experience,
like biomedical conditions, can be explained and predicted through observation and the
mapping of cause and effect relationships. In doing so, it locates the causes of
dysfunctions within the individual, thus, negating the impact of social context and
discourse on a client‟s narrative and lived experience. (Gergen, K; Hoffman, L. and
Anderson, H., 1996)
Relational constructionism assumes that psychotherapy is a particular type of
relationship that is embedded within a specific cultural and professional tradition and
discourse. It also supposes that the way this relationship is framed and performed by its
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participants generate the realities that are lived and experienced during the
psychotherapeutic process. When one views the practice of diagnosis from this
perspective, one can begin to explore and question the degree to which the hierarchical
nature of the diagnostic relationship, where one participant stands from a position of
institutionalized power in judgment of the other, shapes the relationship between them
and influences the realities that are being described and categorized.
With its medical jargon and deficiency based language, diagnostic discourse
has served to privilege a view of social life that stigmatizes personal identity. It is a
discourse based on incapacity and illness. In this manner, it constructs a relational
world in which the person‟s deficiency is the main topic of conversations in therapy and
his or her principal reality. This practice, taken to its extreme, blends the client and his or
her problem into one single entity: the psychological disorder. This in turn reinforces the
person‟s idea that not only is something wrong, but that which is wrong in the client is
him or herself.
A diagnosis can also bestow a social identity based on dysfunction and incapacity.
In as much as its language has penetrated social discourse and has been disseminated
throughout society, it has created a population of consumers of psychological services
that demand the intervention of knowledgeable professionals to provide appropriate
cures. (Gergen, K; Hoffman, L. and Anderson, H., 1996)
The practice of diagnosis has served to reaffirm the idea that psychotherapy is a
techno-medical project where “a human being is a machine and the therapist a technician
that works with faulty human machinery” (Anderson, 1997, p. 67). In doing so, it has
contributed to a discourse that seeks to eliminate uncertainty and inventiveness from the
practice of psychotherapy and is in part responsible, for the recent trend in psychology
that has insisted that all psychological practice be based on empirical data gathered
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through the implementation of experimental clinical trials. This stance has privileged the
use of manuals and standardized procedures to treat specific life problems and mental
disorders, as they appear in the DSM-IV.
Relational Constructionism positions itself against attempts to standardize and
homogenize the practice of psychotherapy. In doing so, it proposes a view of diagnostic
practice that considers it as just another relational move within the context of a social
relationship, which we call psychotherapy. It also sees it as a mode of languaging a
particular form of relationship which has been legitimized within the context of a specific
professional tradition. It questions the truth value of the assertions and methodology used
to produce diagnostic categories and locate clients within them. In questioning the
practice of diagnosis, a relational constructionist stance examines the kind of identities
and social relationships that are created through the diagnostic discourse and whether the
therapeutic realities that it generates lead to more engaging and fulfilling lives, for those
labeled. (Gergen, 2005)
Relational constructionism frees us to re-imagine the practice of psychotherapy
and explore the possibilities generated by our images of its practice. We need no longer
to think of it as a “treatment”, a scientific procedure or a place to acquire an expert‟s
knowledge. Instead, we are invited to envision psychotherapy in more relational ways, as
a form of dialogue or conversation that aims to expand the resources available to the
client, so as to enable and generate new histories, realities, and possibilities of action and
meaning (Gergen, 2005; Botello, 2006)
This approach assumes that what happens in therapy is a product of a relationship
that is constructed in a specific social context. There are no particular standardized
practices or procedures that need to be followed or a specific identity that the therapist
needs to assume. In this sense, what a therapist does and who he or she is, can take
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different forms according to the particular relationship that he or she establishes with a
client. This position assumes that the therapist and client can collaborate together in
defining and negotiating its purpose and goals. They each enter the therapeutic encounter
with different kinds of expertise in specific domains in their personal and social life. The
client in particular, can be seen as possessing important knowledge that enables him or
her to evaluate and decide what is meaningful and what to share within the context of
psychotherapy. (Anderson, 2007).
Living in a constructed world frees psychotherapists from the burden of having to
determine whether the assertions made by a particular model of doing psychotherapy are
“true” or not. Instead, it generates openness towards the use of diverse methods and/or
psychotherapeutic languages that may serve the aims of the therapeutic encounter
(Elkaim, 1997). This means that rather than engaging psychotherapy from a stance that
prescribes a set of techniques, or a fixed position or identity from which to act, it
approaches it with a more pragmatic orientation. It examines the consequences that
different forms of relationships and the conversational moves of each of the participants
have on the therapeutic process. In this sense, all actions are open to review. Instead of
referring to theoretical cannon in order to determine how to proceed, a therapist may
choose to examine the effectiveness of his or her actions. He can explore, for example,
whether they have potentiated or hindered dialogue or forms of life that support the
negotiated purpose of psychotherapy.
In regards to the clients‟ discourse, relational constructionism assumes that a
particular narrative does not represent a literal truth but instead, is a contingent
construction in whose creation participate client and therapist. It also contends that the
stories that are initially told in psychotherapy are not the only ones capable of being
spoken. This implies that the official story, the one that generates and confirms a client‟s
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problematic identity and which is often saturated with difficulties and hopelessness, is
only one amongst multiple narratives that a person may use to signify his or her life.
Viewed from this perspective, the therapeutic relationship becomes the context where
new alternative and hopeful stories may be co-created. They may be built from voices
that have been suppressed or ignored and that hold within them the capacity to make new
meanings and courses of action possible. (Gergen, 2005;White, 2007).
The creation of new narratives and resources for action is generated in the context
of a conversational process that often places the therapist in a “not-knowing” position and
requires what has been called in Zen practice, a “don‟t know” or “beginner‟s mind.” This
is a type of a relational presence that acknowledges the uncertainty inherent in life and
which seeks to face any situation with openness and without attachment to preconceived
ideas, interpretations, or judgments. (Suzuki, 1973; Mitchell, 1976)
In the context of psychotherapy a stance of “not knowing” implies, among other
things, an acknowledgement that its participants cannot predict with certainty the path
that will be taken as a conversation proceeds. How someone will respond to a particular
conversational move can never be predicted with absolute certainty. How conversational
moves are interpreted redirect the conversational dance in psychotherapy in different and
often unexpected directions.
“Not knowing”, therefore, implies living with uncertainty and becoming sensible
to what McNamee (2003) describes as the “interactive moment”. It becomes a relational
space where therapist and client become equals, because neither knows how each
succeeding moment in psychotherapy will unfold. It is also the place where
psychotherapy becomes “art”, where the therapist has the opportunity to use his or her
imagination and intuition to improvise and explore different opportunities and options of
relating and interaction. It is a moment where one can listen to the different voices that
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serve as “internal companions” (friends, mentors, therapeutic models, family, colleagues,
alternate identities) and make use of available conversational resources to deepen the
dialogue and generate unforeseen paths in the therapeutic relationship (McNamee, 2003).
In summary, a therapy informed by a relational constructionist sensibility,
positions the therapist in a reflexive and open relationship to the practice and traditions of
psychotherapy and allows him or her to explore the conversational possibilities inherent
in the therapeutic dialogue. It cultivates a presence that includes and acknowledges
multiple voices, perspectives and identities in therapist and client, and uses them as
dialogic resources that can enable a client to deconstruct what is problematic and re-
imagine that which is possible.
Relational Practices
I have outlined the implications of approaching psychotherapy from a relational-
constructionist sensibility. I now wish to examine three modalities of relational practice
that illustrate the possibilities of action that it can generate in psychotherapy.
Opening a Dialogical Space
A first group of relational practices have as their aim the creation of an open
ended dialogical space in the client-therapist relationship that enables a process of shared
inquiry to occur. This space is generated in part, through the practice of deep and
sensitive listening that brings a sense of curiosity and an interest for capturing and
understanding the client‟s experiences and narratives in their full complexity. Listening
includes and transcends the ability to quietly pay attention. It implies a way of inquiring,
representing and dramatizing what has been grasped in ways that reverberate with the felt
experience of the client and is recognized by him or her as an accurate depiction of his or
her experience.
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Synchronizing and paying attention to different dimensions of language and
human communication may also help to generate a dialogical space. This may mean, for
example, becoming aware of the way in which the client makes use of corporal
expressions, gestures, movements and modulates his or voice to communicate and signify
his or her experience. This sensibility allows the therapist to synchronize and adapt his or
her communication to the spoken and unspoken language and rhythms of the client. It
also allows him or her to step into a person‟s shoes, imagine the world from the client‟s
perspective, and represent dramatically and with feeling the experience of the client so as
to demonstrate that he has grasped his or her story in its full complexity.
Conversational resources such as drama and metaphor may be used in the service
of connecting with the felt experience of the client and creating a context where client
and therapist can begin to relationally engage with each other. They can become useful
tools of relating and moving into the experiential world of the client in ways that can
engage him or her and open up the possibilities of dialogue.
The Cat Lady
Several years ago, a young, 18-year-old woman, who had been diagnosed as a
paranoid schizophrenic, was referred to me. Her prior therapist had informed me that the
woman heard voices and, on occasion, had acted aggressively in her home, using scissors
to cut and shred her clothing in front of her amazed parents. He also claimed that she
had been an unwilling and unresponsive participant in psychotherapy. According to him,
her only meaningful relationship was with a small white cat that she played with and
talked to at home.
The young woman arrived with her parents at the community mental health center
where I worked. She entered alone into my office and sat in a chair beside a desk in the
room. AS she sat, I was able to notice how her make-up intensified the paleness of her
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skin and contrasted with the intense redness of her lips. Her gaze was fixed but seemed
lost in space. This made me wonder how I was going to approach and engage her in
conversation. I began with the introductory rituals which are common in our profession.
I stated my interest in talking with her and helping her. I asked her for her name, the
reason she had come to my office, and whether there were any concerns that she would
be interested in sharing with me. She responded to each question with silence and an
immutable physical expression. During the next few minutes, I attempted different
strategies to initiate a dialogue but all of them failed. She remained resolute in her
refusal to engage me in a meaningful conversation.
I felt frustrated and confused, with few ideas on how to proceed. Then, I
remembered the words of her former therapist and his comment about her relationship
with her cat. At this point, I changed the tone of my voice and softly mentioned that like
her, I had a small pet kitten. To my surprise, her right eyebrow lifted. For the first time,
I had received a response that recognized my presence in the conversation!
I decided to continue talking about the kitten. I described some of his habits and
personality traits. She responded to each piece of additional information with a change in
her facial expression which I interpreted as a sign of interest and curiosity in what I was
sharing. I then decided to take a risk. I mentioned with excitement, that my kitten was
very mischievous and had a habit of interrupting me in the most inopportune moments.
“For example,” I told her, “this morning, while I was doing my homework at my desk,
the kitten came near to where I was sitting, looked at me with her big eyes… and you
know what she did?” I paused for a second and then suddenly jumped on top of the desk.
I stood in four legs like a cat and then and while fixing my gaze on her, I began to meow
loudly like a kitten. Completely surprised, she remained silent for a moment and then
exclaimed, “You‟re crazier than I am!” To which I responded, “Yes, but unlike you, they
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pay me to be crazy.” She sat in silence for a second or two, then, suddenly she looked at
me with an impish grin and began to laugh heartily. She then calmly said, “With you, I
can talk.”
This story illustrates the range of conversational resources available to the
therapist when he or she lets openness, dialogue, and acknowledgement of the other serve
as a guide for his or her practice. It demonstrates how even unusual modes of
communication can be used to develop the relationship between therapist and client. It
also promotes a relational stance that seeks to engage the client in a shared language that
transcends rigid prescriptions about how to proceed in therapy. The therapist maintains
a reflexive awareness of a relational space that includes him or herself and the client and
particularly, those moments when something different or new occurs in the conversation.
Those openings, which can be missed if awareness and sensitivity are missing, allow the
therapist to invent and engage in innovative forms of relationship and explore relational
spaces that make collaboration, dialogue, and transformation in psychotherapy possible.
Co-creation of Competences and Abilities
Exploring these alternative spaces of relationship leads us to a second group of
practices that are fundamental to a relational constructionist approach to psychotherapy:
the co-creation and acknowledging of competencies and abilities. These practices are
founded on the assumption that clients have abilities, strengths, and resources that if
recognized and acknowledged may help generate new constructive ways of solving
problems, finding meaning, and re-imagining their lives (Bertolino and O‟Hanlon, 2002).
The idea that our clients are competent and capable human beings redirects the
psychotherapeutic conversation through paths not envisioned in a deficit based discourse.
It moves us into experiential spaces where the person can acknowledge talents and
capacities that are ignored in the problematic identity that has been shaped through his or
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her official story. It generates a conversation that includes not only what is going wrong
but also what is going well, and explores not only what is limiting and generates
suffering, but also what strengthens and generates meaning. This perspective
acknowledges that, although the person may have problems and that his or her action can
have undesirable consequences, he or she is not the problem (White and Epson, 1990).
There are multiple practices for attending and co-constructing competencies in
psychotherapy. For example, narrative and solution focused and competency based
therapists suggest asking a client directly for experiences in their lives that illustrates
strengths and abilities or where they‟ve demonstrated their capacity to face obstacles,
solve problems, and reach their goals. (Bertolino and O‟Hanlon, 2002; Walter, J. and
Peller, J., 1992; White, M., 2007) Bertolino and O‟Hanlon (2002) also suggest reframing
deficit based descriptions to “normalize” what has been designated as pathological or
faulty. For example, hyperactivity can be re-signified as being filled with energy, and
having oppositional traits can be re-conceptualized as dissidence or the conviction and
willingness to defend one‟s interests when subjected to pressures by those in positions of
authority.
Discovering competencies, however, is not dependent on a particular technique or
a form of questioning. A therapist can assume a mode of listening and participating in a
conversation where he or she is constantly looking for opportunities to frame life
experiences and client traits as examples of strengths and abilities. For example, as he or
she listens, he or she can consider, “How can this expression, this relationship or form of
life referred to by the client, can be seen as a strength? How can it be used as a resource
in psychotherapy?”
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The following narrative of one of my clinical students provides an example of how
attending to, discovering and co-creating competencies in a therapeutic relationship can
help to transform a client‟s identity and modes of relating and acting in the world.
Wild Rose
Rose was a 50 year old woman who was referred to psychological services by
a counselor from a Government Vocational Rehabilitation Program because she had
difficulties “verbalizing her problems or needs”. She also had a stressful life situation
because she was unemployed and had to care at home for a severely disabled
daughter. The program had also requested that a psychological assessment be
conducted in order to assess her “intellectual capabilities so that she could gain
entrance into a vocational program.” This assessment was to be done another
therapist.
When I asked her questions about her life during our first conversation, she
started to speak but would stop, begin gesturing with her hands and head as if saying
“no” and then would state “I don‟t know how to say it, I‟m stuck”. This cycle of
communication was repeated several times during our initial meeting. I sensed that
she was tense and fearful of whatever it was that she thought I was there to do. I then
began asking her questions about everyday activities hoping it would make her feel
more comfortable and allow me to gain her trust. This approach opened up our
conversational space and she began to articulate her story.
Rose spoke about her difficulties in relating to others and about the impact of
having been labeled “mentally retarded” at an early age. She said that people told her
she couldn‟t do things because she was “stupid” and that she was reticent to talk to
others for fear of being ridiculed, so she felt very alone. The thought of undergoing a
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psychological assessment increased that fear because she anticipated that the results
of the tests would deem her incapable of working in any job.
When we engaged in “non-clinical talk”, I discovered that she had a particular
fondness and talent for gardening. It was an activity that she carried out every day
especially, when she was feeling stressed or alone. Upon hearing this, I decided to
mention my lack of talent for tending to plants and told her that all of my houseplants
had died because I could never tell the correct amount of water to use, or when they
needed watering, and whether a particular plant should be indoors or outdoors, among
other things. She then began explaining all of the different ways that plants “told” us
what they needed. Changes in color signaled a need for more or less water; texture
and composition of leaves could “tell you” whether a plant needed to be indoors or
outdoors. When I asked her how she knew all of these things, she mentioned that
these were things she learned only through the experience of having plants and caring
for them in her home. As she continued to share with me her knowledge of plants, I
noticed that she was very comfortable and articulate. There was no hesitation or
“verbal difficulties” when plants and gardening were the subject. We had found,
through the course of the conversation, a “language” that she was very fluent in!
When I shared this experience with my supervisor, he suggested that I explore
other identities besides “being the therapist”. He asked me to let her be my teacher,
so that I could learn about plants and their “hidden language”. He also reminded me
that her relationships with plants could operate as a living metaphor for her
relationship with herself and her own life and could be used as a conversational
resource for transformation.
As I began to relate to her as my new mentor, I discovered that through the use
of plants and gardening metaphors she was able to express her emotions about
21
different situations or the problems that she was experiencing in her everyday life. For
example, when speaking about lacking a sense of order she compared herself to “a
bunch of weeds growing wildly in a yard”. When referring to her daughter she would
say “she is like an orchid, very beautiful but very fragile”. When describing how she
felt people viewed her, she said she thought they saw “a cheap carnation” but that she
felt like a wild rose because “she was beautiful once you got past all of the thorns”.
She also compared the ways she felt when she spoke to plants to how she approached
speaking with people, something, she said, made her very uncomfortable. By
highlighting the different relationships she established with each particular plant and
what worked with them, we were able to explore and generate new ways through
which she could put those abilities to use when speaking and relating to others.
Talking about plants, also allowed us to explore the apprehension she felt
towards the psychological assessment that she needed to undergo in order to qualify
for the Vocational Rehabilitation Program. Her concern, she stated, was related to the
rejection she had felt in the past by others who deemed her “retarded”. Our
relationship however, had given her an experience of relating as an expert with a
“professional as a student” and thus, she had gained a sense of competency, a sense
that she described as the confidence “that I can do things”.
Once she could affirm herself, we began to engage in conversations about
times and domains in her life where she had been successful (graduating high school
and as an exemplary mother who took care of a severely disabled daughter, for
example). This shift in focus allowed her to recognize that she, like other human
beings, had different strengths and weaknesses. This understanding undermined the
narrative that had placed her as being “less”, “stupid” or “not as knowledgeable as
others”. This, in turn, generated unanticipated possibilities for future development.
22
Before ending therapy, we co-created a plan that built on her strengths and that she
could use to participate in new activities and social situations, as well as prepare for a
future job in gardening.
I later heard from her rehabilitation counselor that she had enrolled in and
successfully completed a program where she was certified to do gardening work. The
counselor was surprised to find out that the woman that had been plagued with so
many difficulties now seemed changed and transformed. In her conversations with
him, this “new woman” he said, “constantly reminded me that she had a talent and
passion for something that not everyone could do”! (Soliz-Baez, 2009)
This story illustrates a way of doing therapy that invites a person to reconsider
his o her life from positive and change promoting perspectives. New stories that
stress vitality and meaning can be co-constructed. Through these new stories, events
may be re-signified, forgotten narratives can be restored, and experiences that reflect
a person in more meaningful ways can also be explored. In this way, a client can
participate in the creation of narratives that assert his or her strengths and capacity to
rethink and re-evaluate his or her past and future.
Reaffirming what is best in a person does not imply a new, repackaged version
of positive thinking. This practice does not privilege a particular way of thinking or
being. Neither does it deny that there is suffering and hurt in life. It refuses,
however, to privilege perspectives that have turned naming and explaining what is
dysfunctional as one of the unquestioned needs in psychotherapy. Instead, it proposes
an alternate approach to therapy that acknowledges the human potential to reinvent
oneself, to overcome suffering, and to act in accordance with one‟s most noble
aspirations.
23
The Crisis of Faith
Clients‟ troubled stories are often saturated with suppositions and experiences that
operate as truths and natural realities. In order to question these, there is a third group of
relational practices whose goal is to provoke a crisis of faith in the client‟s beliefs and
ways of relating which help to maintain problematic narratives and identities. They seek
to “demonstrate and experience the constructed nature of concepts we take as a given”
(Botella, 2006, p.30), and destabilize and break the perceptual “curse” through which an
identity, a way of relating, or a problematic story are assumed to be the only possible
reality. They also maximize opportunities for breaking down the foundations of any
assumption, belief, or idea that taken as an absolute truth has served to limit the ability of
a client to re-signify his or her story and/or generate a more hopeful and enabling
narrative.
In attempting to provoke a crisis of faith, a therapist takes advantage of
inconsistencies that may appear within a particular discourse or alternate identities and
narratives that don‟t form part of the official story. Different conversational and
relational resources, such as reflective dialogue, hyperbole, paradox, challenge, humor,
analogy, metaphor, and story, may be used to generate a crisis of faith. Different
dramatic modalities such as role-playing real and imaginary figures can also be
employed.
Using these resources requires that a therapist be able and willing to alter the
expression of his or her identity in ways that allow him or her to adapt to the changing
conditions of his or her relationship with the client. This implies, for example, that on
occasions, a therapist may assume an identity that expresses empathy and compassion,
while at other times he or she can become an incisive and persistent inquirer. The
24
therapist can also become a storyteller, perform multiple dramatic roles, and make
extensive use of metaphor and humor (Gilligan, 1997).
By not maintaining a fixed identity, the therapist turns into a form of audience
that can respond in unusual and unexpected ways to the client‟s stories and ways of
relating. This makes him or her unpredictable and difficult to place. The client‟s
narrative and dramatic expression may be left without the audience and the form of
relationship needed to maintain it. This may provoke alterations in the client‟s identity
and mode of relating in order to respond to the new relational context where the story is
being told.
A crisis of faith can occur when client and therapist collaborate together in
accessing realities and perspectives that undermine the beliefs and ideas that sustain the
client‟s official story. This may require the recall and exploration of experiences that
have been marginalized and discounted as a strategy to undermine the truth that hold the
client‟s imagination in captivity.
The Community Organizer
Several years ago, a client who worked as the administrator of a community based
enterprise, asked me to meet her in her office in order to deal with a personal crisis.
When she called, she was in a heightened state of anxiety. She had been weeping locked
in her office for more than two hours. That afternoon, the Board of Directors of her
organization, was holding an emergency meeting that required her presence. She was
concerned, that because of her emotional condition she would be unable to attend. When
she asked me for my help, she told me, “I don‟t think I have a way out. Given how I feel,
I can‟t possibly be at that meeting in two hours.”
When I arrived at her office, I found her inconsolable, repeating over and over
again: “I have no future”; “My life is over”. When I asked her what was wrong, she told
25
me that during the last few weeks, a regional newspaper had been publishing a series of
articles that questioned her organization‟s business practices. In an article that appeared
in that day‟s newspaper, she had been accused of corruption and of using the
organization‟s deposits for personal gain. She maintained that all the information was
false and that the reporter had never interviewed her to corroborate the charges that
appeared in the article.
I listened to her attentively, while she explained how she felt ashamed and
humiliated. She was worried that her grandmother and daughter, (whom she had raised
as a single mother), would read the newspaper and think that she had been engaged in
criminal acts. She was also concerned about her professional reputation and her standing
in her community. Full of sadness, she lowered her hear and broke into tears. Then she
added: “What‟s worse is that the only thing I hear in my head is the reporters „damn‟
voice, accusing me again and again of being a thief… I just feel there‟s no way out.”
As I listened to her for the next few minutes, I remembered several of our
previous conversations and her history as a community leader and a responsible single
mother. I waited for a moment of silence. Then I asked her in a paused and dramatic
tone, “I understand you can hear his voice, but I wonder if you can listen to the other
voices.” She looked at me with a perplexed gaze and asked me, “What voices are you
referring to?”
“Your grandmother and your daughter‟s voices…” I paused for a few seconds
before going on. “If they were to stand here, in this office and saw you crying, would
they speak to you as he does?” “Would they say the same things?” I paused again, giving
her a moment to consider my question. I then went on, speaking carefully and slowly. “I
don‟t know if you can listen to their voices…. I don‟t know if you can notice and feel the
way they would approach you.”
26
She stopped crying and answered, “They would give me support. They would say
they love me and my daughter would hug me.” Then, I asked, “Now, that you can see
their loving eyes, and listen to their words and feel your daughter‟s arms around you…
how does that make you feel?” “A lot better” she answered.
By now, her breathing had changed and had become deeper and fuller. I
continued, attempting to engage her through my words. “I know you can already listen to
their voices, but the one that‟s here is in crisis. There are other voices that are needed. “
Curious yet puzzled she asked, “Who are you referring to?”
I answered as if it was obvious, “Well, you know the others….the woman that
overcame all kinds of difficulties through her own efforts, the one that raised a daughter
and took care of her grandmother. Is she here? Can you hear her? ” I paused for a few
seconds, long enough to notice that her eyes were no longer reddened by tears. “Then
there is the community leader, the one who helped the elderly, students, and the poor …
Is she here? Can you listen to her?” Again I paused. “And then there are the thankful
voices, the others that have blessed you in their prayers. Are those voices here with you?
Can you listen to them? Can you feel them as they speak to you and remind you ….?”
The change was already noticeable. Fragility gave way to determination and
confidence. Then she said, “I feel as if I have all of them here with me, talking to me,
giving me support. I had forgotten I have a lot of people on my side.”
This was the beginning of a fruitful conversation that helped her to reconsider the
many “truths” that she had taken for granted. She discovered, for example, that the
reporter‟s voice was one among many voices that she could listen to. When she began
our conversation, there only existed two voices in her conversational space, her accuser‟s
and the one who belonged to a woman isolated and weakened by his accusations.
Through our dialogue, other voices, identities, and points of view emerged that
27
questioned the realities she had taken for granted and helped reaffirm her worth and gave
her back her sense of purpose.
This example dramatizes the way though which the therapist and client can
participate in deconstructing and co constructing the realities in psychotherapy. Through
listening and communication, the therapist acknowledges the importance of what the
client feels. He uses different ways of speaking to generate a dramatic intensity and
capture the listener‟s attention. Through use of questions and suggestion, other social
realities emerge. The client enters a world where families, friends, and colleagues join
together as a supportive and affirming imaginary community that enables her to question,
reconsider and re-imagine her situation.
Each of these relational moves acquires meaning in the nexus of the relationship
with the client. As a therapist, one is led by what one listens to and the way the client
responds and attributes meaning to what one does. In this case, the client accepted an
invitation and collaborated with it. Through words, silences, and gestures a
conversational dance was created. The co-created language of words, silences, gestures
and body movements made it possible for the client to question what had once seemed
like fixed and unalterable realities. Through that language, an alternate identity that
generated new possibilities for action was forged. It allowed this client to access and rely
on a community of imaginary presences and relationships to re-signify and discover her
strength in the face of what once seemed to be a serious and insurmountable threat to her
personal integrity.
Final Observations
I have presented a view of psychotherapy founded on the constitutive power of
language and human relationships which conceives psychotherapy as a conversation, in
which the therapist and client participate in the co-construction and re-construction of
28
pasts, presents, and futures. I have also suggested that these realities are ever changing
and uncertain. That is to say, we never know exactly what awaits us in the conversations
we hold in psychotherapy and what meanings will be generated through them. In facing
uncertainty, I have suggested the importance of being sensible in the interactive moment,
because as Gergen (2005) states, “We never know when or how a door will open (if it
opens) into another better way of living (according to a certain point of view).” (p.174)
Acknowledging the constitutive power of language has important implications for
the therapist. It makes him or her question forms of language and relating that generate
realities which incapacitate and restrict the ability for reinvention. It also leads the
therapist to undertake practices that open up new possibilities of relationships and re-
imagination. I explored three of these in this text and, through examples, illustrated ways
in which they may be used. These, however, are only a few of the many of dialogic
options that therapists may access when he or she relates from a stance that acknowledges
the participatory and co-constructed nature of the realities that client and therapist live, in
and outside of therapy.
In concluding, I wish to borrow Gergen‟s (2005) proposal to re-conceptualize
psychotherapy. He suggests that instead of using a language based on mechanics and
cybernetics to describe psychotherapy, we are better served by the use of a more
imaginative and literary approach in our conversation. He challenges us to re-imagine
psychotherapy as a literary form that can be founded on three characteristics of poetic
language: the capacity to scrutinize what is common and ordinary, to make the
imaginative credible, and to generate an aesthetic sense in the relationship between client
and therapist.
Gergen‟s proposal synthesizes the essence of what I have shared. It invites us to
re-imagine psychotherapy and our work as therapists. It suggests that we free ourselves
29
from orthodox clinical chains that, with their deficiency based language, prescriptions,
and pretensions of control and prediction, transforms psychotherapy into a technical
activity that lacks imagination and soul. It proposes a vision that empowers the client and
makes them a participant in the co-generation of realities that are re-invented through the
psychotherapeutic dialogue. It also invites us to use our imagination to participate in a
poly-vocal and pluralist world, where our relation to the unknown and the unforeseen
generates mystery and enables the possibilities of creation. Listening to, immersing
ourselves in experiential worlds, questioning and destabilizing, generating alternate
futures, and establishing a certain aesthetic in our ways of conversation and interaction,
all are part of the rich tapestry and dance we call psychotherapy. Therapist and client
speak together to reconsider the old and reinvent the new, to re-imagine and generate as
Gergen (2005) says, “a discourse of dreams, a discourse that believes in the image of
what is to come, of a hopeful, stimulating and captivating future.” (p.81)
30
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