Social ambivalence towards psychotherapy

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Post-modern thought

Post-modern thought pivots around the idea of rejecting the „self‟ as the only processor of one „true‟ reality. It recognizes that many characteristics of life are reflections of reality, thereby accepting and encouraging a plurality of voices. It is a paradigm that promotes the deconstruction of absolutes in order to make way for multiple realities. Post-modernism also asserts that „privileged positions‟ of observation do not exist, therefore questioning the very power hierarchies existent in „traditional‟ schools of thought (Becvar & Becvar, 2000; Doherty, 1999). The essence of post-modernism is in allowing something new to evolve, rather than predetermining the rules for what is real and valid in the world, this requires resilience of the therapist (Doherty, 1999). The post-modern therapist therefore faces specific and difficult challenges.

Post-modern „self‟

It has been discussed that context defines beliefs and that each person is ultimately responsible for their beliefs. The context that defines these beliefs is a reality that is ultimately flexible. However, many people believe that their identity is fixed. They typically employ terms such as „thought‟, „emotion‟, „motivation‟ and „attitudes‟, as if they referred to absolutes of existing states or entities within society and the individual (Gergen, 2003). Such words or descriptions often have long standing connections to historical or anthropological literature that relates to discourses of the „self‟ (Freeman, 1998). This realization exhibits how living traditions and meanings are open to radically evolve given the right conditions. This influences daily discourse. In this sense, the vocabularies of „the self‟ within society set the grounds for much of the experienced self in social activity (Gergen, 2003).

An uncertain role

One of the general opinions fuelling dislike or mistrust of psychotherapy seem to relate to people‟s uncertainty or lack of knowledge regarding what psychotherapists actually do (Duncan & Moynihan, 1994). Regardless of their experience of psychotherapy, most people would largely agree that the psychotherapist is required to play a significant, defining and shaping role in the psychotherapy process. However, exactly what this role should be remains strongly debated, with many people complaining that their therapeutic experience was either disappointing or „abusive‟. Finding the balance between respecting the client and the „persuasion‟ to change appears to be a challenging role. This balancing act is often a teetering between perceptions where the client fears that the therapist will do nothing, juxtaposed against the fear that the therapist may control the client.

Post-modern therapist

Clients often view psychotherapists as representing an objective and independent source of reality, some form of social authority that will offer „correct‟ assistance or guidance in changing their lives. Clients also hope that the therapist will assist them in „fixing‟ or changing their problems, possibly even convince their partners or family that they „the client‟ are correct in what they are feeling or experiencing. This expectation puts psychotherapy in a powerful position, a position where the therapist‟s words are often taken as truth. Unfortunately this position also exposes the client to potential power abuses and disrespect, while offering no guarantee of actual help (Robbins, 1999). Post-modern thought recognizes this dilemma and chooses to view psychotherapy from a more holistic, social perspective, rather than from a purely „medical‟ perspective. Such a shift in focus is an attempt to rectify the imbalanced relationship dynamics reported in psychotherapy, and in the process offers an opportunity for a more useful dialogue to emerge (Owen, 1993).

The Therapeutic Alliance

Since the beginning of psychotherapy, the therapeutic alliance has developed into one of the most important variables in understanding the psychotherapy process and its outcomes. Ackerman and Hilsenroth (2003) point out that effective treatment outcomes rely on the therapist‟s capacity to recognize and effectively control „negative‟ or unpleasant processes in psychotherapy. This is done in order to preserve a healthy and constructive therapeutic relationship which may assist with avoiding premature treatment termination.

TABLE OF CONTENTS :

• CHAPTER 1 .INTRODUCTION
  • Introduction
  • Aim of this study
  • Approach
  • Explicit, implicit and tacit knowledge
  • Psychotherapy definitions
  • Questioning psychotherapeutic effectiveness
  • A fragmented history
  • A changing society
  • Medicine versus healing – conflicting principles
  • Social ambivalence towards psychotherapy
  • Ambivalence in the media
  • Consumerism – The therapist‟s dilemma
• Chapter de.scription
  • Conclusion
• CHAPTER 2 .PSYCHOTHERAPEUTIC EFFECTIVITY
  • Introduction
  • Recurring themes
  • The question of psychotherapeutic effectivity
  • Efficacy of psychotherapy versus pharmacology
  • Equality of all therapies
  • No psychotherapy equivalence
  • Specific and preferred effective approaches
  • Cognitive-Behavioural Therapy
  • Interpersonal Psychotherapy
  • Behavioural Therapies
  • Short-term and Psychoanalytic Therapies
  • Effective „behavioural‟ psychotherapy
  • Efficacy of empathy
  • Embracing the client‟s ecology
  • Private practice outcomes
  • A post-modern perspective on psychotherapeutic effectivity
  • Conclusion
• CHAPTER 3 .THE EPISTEMOLOGICAL WINDOW „Knowing about knowing‟
  • Introduction
  • Therapeutic conversation: engendering change
  • “Knowing about knowing”
  • Understanding Theory
  • A Deeper Description of Epistemology
  • Ecosystemic Epistemology
  • Dualism versus holism
  • Cybernetics and constructivism
  • Distinction
  • Cybernetics of cybernetics
  • Constructivism
  • Objectivity and constructing reality
  • Social Constructionism
  • Social criticism
  • Scientific Criticism
  • The influence of language
  • Context-bound
  • Post-modern thought
  • Post-modern „constructivist‟ therapist
  • Post-modern „self‟
  • Conclusion
• CHAPTER 4 .A POST-MODERN MAP TO RESEARCH
  • Introduction
  • Defining research
  • The researcher‟s constructions
  • The relevance of theory choice
  • Questioning that which is
  • The post-modern lens
  • Objectivity
  • Dualism
  • Reciprocal creation of „reality‟
  • Context
  • Co-creating and collaborating „meaning‟
  • Constructionism
  • Co-authorship
  • Questioning power: the feminist biographical approach
  • Qualitative Methodology
  • Method of this study
  • The Context
  • Style of inquiry
  • Research design
  • The Human instrument
  • Sampling and Selection
  • Data collection
  • Data analysis
  • Tangible reports
  • Self-reflexivity
  • Researching through Narratives
  • Tacit Knowledge
  • Synopsis of research methods: instruments and processes of analysis
  • used in this study
  • Approach
  • Participant selection and data collection
  • Data analysis and integration
  • Conclusion
• CHAPTER 5 .POST-MODERN THERAPIST
• CHAPTER 6 .LANGUAGE, SOCIETY AND TRANSFORMATION
• CHAPTER 7 .PSYCHOTHERAPY AND SOCIAL DISCOURSE
• CHAPTER 8 .VOICES IN PSYCHOTHERAPY: “REFLECTIONS OF SOCIAL DISCOURSE”
• CHAPTER 9 .EVOLVING CONVERSATIONS
• CHAPTER 10. CONCLUSION AND RECOMMENDATIONS

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PSYCHOTHERAPEUTIC EFFECTIVENESS AND SOCIAL DISCOURSE: AN ECOSYSTEMIC EXPLORATION