The role of the group therapist in a modern paradigm

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As I have already mentioned, my preferred philosophical stance is grounded primarily in a postmodern epistemology. The purpose of this chapter is to reflect on postmodernism, on the roles of the pastoral group therapist and the client in a postmodern paradigm, and on how postmodernism influences my knowledge of depression.
First, I reflect on how I was introduced to postmodernism, how postmodernism influenced my thinking and on social constructionism as a postmodern discourse.


I encountered postmodernism at a time in my life when I had begun to question the certainty with which people in authoritative positions (such as pastors) claimed to hold the truth. Postmodernism, along with theories of poststructuralism, resonated with some of my own questions about truth and authority, questions such as these: Who knows the truth? Is there such a thing as absolute truth? Who has the right to claim their knowledge as truth? Is truth a universal phenomenon, or is it local?
The work of feminist writers such as Ackermann, Bons-Storm and Cozad Neuger also attracted me and I was drawn to the ideas of contextualising, of giving people a ‘voice’ (especially those who are marginalised), of the communal basis of knowledge and of the significance of power relations. For feminists who position themselves within a postmodern paradigm, an empiricist orientation to knowledge is not generally a congenial perspective, because such an orientation covertly advocates the manipulation, suppression and alienation of those one wishes to understand. Furthermore, from a feminist perspective, empiricist science seems to have been most often employed by males to construct views of women that contributed to the subjugation of women (Gergen 1985:272; Russel & Carey 2003:71).
These ideas mentioned above made even more sense to me when I became more familiar with the work of Foucault (the dominant poststructuralist thinker that influenced narrative therapy) and with how he challenged knowledge and its assumptions. His work deconstructs much of what we take for granted and shows how objects of knowledge are constructed by discourse, which determines what is seeable and sayable and by whom. To me, Foucault’s understanding of the relationship between power and knowledge and how power produces reality opened up new ways of thinking (White cited in Besley 2001:74; Townley 1994:17).
When I started with my first group for people with depression, I used a number of narrative ideas and techniques that I had become acquainted with. Because narrative therapy is positioned within postmodern, poststructuralist discourses, I was also exposed to a poststructuralist, postmodern, narrative, social constructionist world view. This exposure made me realise that it was particularly helpful to approach people and their problems with attitudes supported by the ideas offered by such a world view. In this sense, narrative therapy has transcended the scope of being a mere therapeutic technique, and has become a lifestyle and a political project (Besley 2001:78; Freedman & Combs 1996:22).

A postmodern view of knowledge

The ideas represented by a postmodern world view comprise a radical questioning of the foundationalism and absolutism of modern concepts of knowledge. Postmodernism is a rejection of both the idea that there can be an ultimate truth and of structuralism (the claim that the world is the result of hidden structures). Postmodernism provokes an attitude of uncertainty and unpredictability, of studied doubt; and any attempt to gain knowledge involves a continual reflexivity which underlines the provisional and transitory nature of that knowledge. This doubt and reflexivity also inform and subvert self-knowledge. Change is a given and is embraced (Anderson 1997:36; Burr 1995:13; Parker cited in Lowe 1991:43).
Postmodernism also rejects the modernist claim that the world can be understood in terms of grand theories or meta-narratives; and emphasises instead the co-existence of a multiplicity and variety of situation-dependent ways of life. Postmodernists choose to look at specific, contextualised details more often than at grand generalisations, at difference rather than at similarity. Postmodern thought moves toward knowledge as a discursive practice, towards a plurality of narratives that are local, contextual and fluid (Anderson 1997:36; Burr 1995:14; Freedman & Combs 1996:21-22).
When we use the narrative metaphor (as influenced by postmodern discourses) to orient our work as therapists, we are intensely curious about the ‘local knowledges’ of each new person we meet. What people are feeling, what they are undergoing, how they perceive this, how they are responding – these are the experiences that constitute the primary data of the context (Cochrane et al 1991:17). Such an approach opens up multiple interpretations of reality and experience, rather than to reduce interpretations to the clarity of a diagnosis (Freedman & Combs 1996:31).
Postmodernism aims its attack mainly at the production and maintenance of knowledge, the question of authority, and the shortcomings of a representational view of language. In this way, rather than focusing on any given pathology (in this case depression), it pays attention to the ways in which certain realities have been dynamically constituted through discourse. Discourses are about what can be said and thought and about who can speak and with what authority (Ball cited in Lowe 1991:44). Discourse thus constitutes knowledge and confers power.

A social construction discourse

It is a central tenet of social constructionism and a postmodern discourse in a postmodern world view that beliefs, laws, social customs, habits of dress and diet arise through social interaction over time. People construct their realities together as they live them. Knowledge is thus socially arrived at and it changes and renews itself in each moment of interaction. Knowledge is continually evolving and continually broadening (Anderson 1997:36; Freedman & Combs 1996:23). I therefore try my best to allow the group participants to create their own meanings of depression according to how it operates in their lives, as suggested by Penwarden (2006:65).
Social constructionist inquiry is principally concerned with explicating the process by which people come to describe, explain or otherwise account for the world (including themselves) in which they live. Social constructionism proposes that we adopt a critical stance towards our formerly taken-for-granted ways of understanding the world, including ourselves. Social constructionism sees the ways in which we understand the world as culturally and historically specific. The categories and concepts that people use are products of that culture and history. Dualisms or oppositions are also seen as socially constructed rather than real.
Today, the church is also beginning to realise that dualisms are social products of modernism and is starting to move away from dualisms such as ‘holy’ versus secular, theology versus ethics, the individual versus the community, and is shifting towards more holistic thinking (Niemandt 2007:73).
Social constructionism sees knowledge as sustained by social processes, as people construct knowledge between them, through language. Language is regarded as mediating or constructing reality, rather than reflecting or representing reality. According to social constructionism, knowledge and social action go together. Knowledge is therefore not seen as something a person has, but as something that people do together. Social constructionism emphasises the relational nature of knowledge and the generative nature of language (Anderson 1997:36; Gergen cited in Burr 1995:2-8; Gergen 1985:266-267; Lowe 1991:43-44).
Depression is a word that came into use in the twentieth century to signify that a person is experiencing a sense of low energy, is in a ‘down’ mood or restless, or, at the other end of the spectrum, it can mean that a person is experiencing symptoms of an overwhelming lethargy that saps his or her interest in living (Cozad Neuger 2001:149-150). It can refer to any number of symptoms or experiences between these two ends of the spectrum. Unlike the DSM IV suggests, the word ‘depression’ does not have a ‘fixed’ meaning.
Later in this chapter I discuss how my knowledge of depression has been influenced by postmodernism, social constructivism and poststructuralism.


A poststructuralist discourse

According to Derrida (cited in Freedman & Combs 1996:29), meaning is not carried in a word by itself, but by the word in relation to its context, and no two contexts are exactly the same. Therefore the precise meaning of any word is always somewhat indeterminate and potentially different, and it should be negotiated between two or more speakers.
This inevitable mutability of language can be useful, as it makes our conversation with the people we work with opportunities for developing new language, thereby negotiating new meanings for problematic beliefs, feelings and behaviours – new meanings that can give legitimacy to alternative views of reality (Freedman & Combs 1996:29). In this regard externalised language (as used in narrative therapy) is very helpful to separate the person from the problem, thus creating space for new meanings to develop (Morgan 2000:17,18; White 2007:26).
Western psychologists tend to have privileged the construction of the self as an individualised, skin-bound ‘true self’ or ‘essential self’, which is primarily seen as stable and singular. A postmodern concept of different experiences of a self brings home the notion that ideas of the self, like other constructions, are formed through social interaction within particular cultural contexts; and the self is subject to change. ‘Selves’ are thus socially constructed through language and maintained in narratives (Besley 2001:79; Freedman & Combs 1996:34; Sampson 1989:2). The notion that externalising conversations establish a context in which a person is separated from the problem, so that the problem becomes the problem, and the problem no longer speaks to them of their identity and alternative descriptions of self can be explored (Besley 2001:76; Morgan 2000:24; White 2007:9).
Derrida’s view of deconstruction describes the undoing of the centre (for example, the ‘essential self’) and the certainty that marks so many Western ‘master-designed’enterprises. Thus individuals are not in the centre, fully aware and self-present masters, but have been decentred. This introduces a picture of a subject who is open-ended, indeterminate and multi-dimensional, rather than the integrated hierarchically arranged Western conception held for so long (Sampson 1989:15).
As different selves emerge in different contexts, no one self is truer than any other and, as people are continually constituting each other’s selves, there are many possible stories about self.
Instead of looking for a centred essential self, therapy can attempt to bring out into the light various experiences of self and to distinguish which of these selves clients prefer in which contexts. Therapists then work toward assisting them in living out narratives that support the growth and development of these ‘preferred selves’ (White cited in Besley 2001:78; Freedman & Combs 1996:35).


In the light of the above discussion on the role of a therapist using theories of poststructuralism within a postmodern paradigm as my philosophical underpinning and my positioning of myself as a therapist, it is clear that I have adopted a profoundly different position from the position that I might have assumed within a modernist paradigm. These roles are now discussed in more detail against the backdrop of postmodernism and a social constructionist discourse.
When I was introduced to postmodern ideas, I already had a therapeutic group for people with depression. I remember the sense of relief I felt when I realised that I did not have to bear the burden of being the expert responsible for a cure. Coming from a ‘not-knowing’ position made me feel much more comfortable and ethical as I began to learn from the group participants as their stories unfolded. I realised that every person in a group has expert knowledge about his or her life story; and it was exciting to learn from everyone else in the group. It was also enriching to open up my own life to share and to be influenced by the group members and their stories. We saw ourselves as a team, collaborating with each other to find new stories.
At first it was quite scary not being able to ‘prepare’ for a group session, as there was no recipe or programme to follow (as there would have been in a modernist approach). I discovered, however, that I could just be myself and trust the conversational process to open up space for new possibilities. In the process, I too was ‘reconnected to ways of being that are congruent with who I believe I am and who I choose to be’ (Alec Ross cited in Freedman & Combs 1996:xiv).
A postmodern therapist’s position rests heavily on the view that human action takes place in an understanding of reality that is created through social construction and dialogue. The therapeutic conversation is a mutual search and exploration through dialogue, a two-way exchange in which new meanings continually evolve toward the ‘dis-solving’ of problems. The focus of a collaborative approach is thus a relational system and process in which client and therapist become conversational partners (Anderson 1997:95; Anderson & Goolishian 1992:26-27).
In a collaborative approach, the expertise of the client and the therapist combine and merge. A client brings in expertise in the area of content, because a client is the expert on his or her life experiences. A therapist brings in expertise in the area of process. The role of the therapist is that of a conversational artist – an artist of the dialogical process– whose expertise is in the arena of creating a space for and facilitating a dialogical conversation (Anderson 1997:95; Anderson & Goolishian 1992:27). My philosophical stance is therefore a de-centred and yet influential position as a therapist, putting the person’s knowledges and skills of his or her life at the centre of the conversation, as suggested by White (cited in Russel & Carey 2003:80).
With the notion of therapy as an art of conversation, where the therapist invites and allows the client to collaborate, responsibility becomes shared, and dualities such as subject-object (as described in Section 2.2) and a hierarchy between client and therapist collapse. Therapy entails an ‘in there together’ process. The therapist is a co-participant ‘in’ a conversation, rather than an expert who ‘uses’ conversation. People talk ‘with’one another and not ‘to’ one another. The therapist and client participate in the co-development of new meanings, new realities and new narratives (Anderson 1997:105; Anderson & Goolishian 1992:28; Lowe 1991:46).
A postmodern therapist exercises this therapeutic art through the use of therapeutic questions which serve as a primary instrument to facilitate the development of a conversational space and the dialogical process. To accomplish this, the therapist exercises an expertise in asking questions from a position of ‘not-knowing’, with an attitude of genuine curiosity, rather than asking questions that are informed by a specific method which demands specific answers. A postmodern therapist takes more of an ‘I am here to learn about you from you’ stance. Central to this therapeutic stance is the therapist’s honest and sincere capacity to be receptive to, invite, respect, hear and be engaged in a client’s story. A ‘not-knowing’ stance requires that the therapist’s understandings, explanations and interpretations in therapy should not be limited by prior experiences, preconceived opinions or expectations, or theoretically formed truths, and knowledge (such as that contained in the DSM IV). The therapist’s role is to facilitate an emerging dialogical process in which ‘newness’ can occur. The therapist positions himself or herself in such a way as to be informed by the client. It is a stance that ‘maintains that understanding is always interpretive and that there is no privileged standpoint for understanding’ (Wachterhauser cited in Anderson & Goolishian 1992:28-29; Besley 2001:81). My philosophical position is thus one of joining with the client in a mutual exploration of the client’s understanding and experience; the process of interpretation becomes collaborative.
A non-hierarchical, non-interventionist position does not equal passivity. It does not mean that anything goes or that the therapist is not influential. As I have already explained in the first chapter when I used White’s graph (see Figure 1.1 in Section to illustrate the different ‘postures’ that a therapist could take up in therapy, my preferred therapeutic position can be described as a de-centred and influential position. When a therapist adopts a de-centred position that grants primary importance to the client’s world views, personal stories, meanings and understandings. The therapist is influential in the sense of building a scaffold through questions and reflections. A therapist is always influencing the client through the questions that are asked, likewise.
1.1 Introduction
1.2 Research curiosities
1.3 Research question
1.4 Research aims
1.5 My own journey
1.6 A philosophical stance
1.7 Research approach
1.8 Research process
1.9 Ethical considerations in doing research
2.1 Introduction
2.2 Modernism
2.3 The role of the group therapist in a modern paradigm
2.4 Ethical concerns
2.5 The role of the client (group participant) in a modern paradigm
2.6 A definition of depression
2.7 Conclusion
3.1 Introduction
3.2 Postmodernism
3.3 The role of a group therapist in a postmodern paradigm
3.4 Ethical concerns
3.5 The role of the client (group participant) in a postmodern paradigm
3.6 A postmodern definition of depression
3.7 Conclusion
4.1 Introduction
4.2 First focus groups
4.3 The interim
4.4 Second focus groups
4.5 Conclusion
5.1 Introduction
5.2 Reflection on first focus groups
5.3 The interim 1
5.4 Second focus groups
5.5 Conclusion

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