Chapter Eleven: Constructivist Theory and Therapy

Historical Context

Constructivist theory is still evolving Many voices, many points of view

Sources and Forms of Constructivist Theory and Therapy Milton Erickson

– Strategic hypnotherapy– Solution-based

Palo Alto and Italy– DBCP– MRI– Milan Center

Solutions and Narratives

Solution-focused brief therapy

Narrative therapy

Theoretical Principles of Constructivist Theory and Therapy

Postmoderism Language and languaging Change as constant and inevitable Therapy is collaborative Focus on positive, strengths, solutions

Theory of Psychopathology

Ineffective solutions Belief in unhealthy narrative

The Practice of Constructivist Therapy

Preparing yourself

Preparing your client

Assessment Issues and Procedures

Specific Assessment Techniques

Opening session Scaling questions Percentage questions Assessing client motivation

Specific Therapy Techniques

Pretreatment change question Externalizing conversations Carl Rogers with a twist Relabeling Presuppositional questions Formula tasks Letter writing Reflecting teams/therapeutic breaks

Extended Case Example

Bob Bertolino’s work with Richard and Laura

Therapy Outcomes Research

Solution-based: Brief therapy has been shown to be effective, and solution-based is brief.

Narrative: Symptom based assessment is too narrow to address changes.

Multicultural Perspectives

Respect for the individual Respect for the context Respect for diversity

Concluding Comments

Constructivists are a diverse group. Can be seen as unfeeling and shallow However, many techniques can be deeply

involving and effective

Student Review Assignments

Critical corner Reviewing key terms Review questions

Critical Corner De Shazer and others contend that since therapy usually

only lasts 6-10 sessions, it is the therapist’s responsibility to work within that framework. Although this statement makes sense on the surface, it is so absurdly general and nomothetic that it constitutes gross neglect of the individual and the ideal. To assume that every new client is just another average 6-10 session client is completely counter to narrative, constructive principles. It succumbs to external socio-scientific-cultural-political forces currently operating in the world, rather than legitimately constructing a unique therapy designed to meet the needs of distressed individuals. In this way, de Shazer advocates a therapy of what tends-to-be rather than a therapy of exciting new possibilities.

Critical Corner (continued) Many constructive therapy books and resources (especially those

emphasizing solution-based approaches) repeatedly proclaim the nearly magical power of solution-focused interventions. Typically, numerous cases are presented in which the astute and clever therapist almost tricks the clients into focusing on their positive attributes. In the end, thanks to the solution-focused approach, the clients quickly succeed in meeting their treatment goals and leave happily ever after. The truth is that solution-based approaches are briefer than traditional approaches and result in goal attainment principally because the criteria for success are set so low and the therapist gives many indirect and some direct messages to clients that they’re really not particularly interested in discussing deeper emotional issues. Its no wonder why there aren’t any controlled outcome studies because solution-focused therapists are in such a hurry to get clients out of their offices that they would never take the time needed to conduct a systematic and depth-oriented evaluation of therapy efficacy.

Critical Corner (continued)

Constructive theory claims to be an egalitarian approach to therapy. However, the approach is extremely value-based and invalidating of clients’ experience of their personal problems. How can constructive theory be egalitarian when it blatantly leads clients toward focusing on positive solutions and sparkling moments?

Critical Corner (continued)

Narrative and constructive approaches often sound more like philosophy than psychology. Constructive writers emphasize lived experience, discourse, contemporary hermeneutics, and the value of not knowing {Anderson, 1998 #507}. Isn’t it likely that all this philosophizing about the human condition moves the therapist away from establishing the deep human connection necessary for therapy to work?

Review Key Terms

Constructivism Postmodern philosophy Utilization Solution-focused brief therapy Solution-oriented (possibility) therapy Narrative therapy

Key Terms (continued)

Ripple effect Assimilation Accommodation Lived experience Problem externalization Credulous assessment

Key Terms (continued)

Formula task Pretreatment change question Unique account or sparkling moment Externalizing conversation Carl Rogers with a twist Relabeling or reframing

Key Terms (continued)Formula task Pretreatment change question Unique account or sparkling moment Externalizing conversation Carl Rogers with a twist Relabeling or reframing

Review Questions

Who was the first contemporary constructive therapist?

What is Milton Erickson’s “utilization” technique?

What is “positive connotation” and what research group came up with positive connotation as a technique?

What is a sparkling moment or unique outcome?

Review Questions

What are the main differences between Ellis’s REBT and Beck’s Cognitive Therapy?

What are the five bedrock assumptions of Ellis’s REBT?

Meichenbaum’s approach is based on verbal mediational processes. In practical terms, what does he mean by verbal mediational processes?

Review Questions (continued)

Who was the first contemporary constructive therapist?

What is Milton Erickson’s “utilization” technique?

What is “positive connotation” and what research group came up with positive connotation as a technique?

What is a sparkling moment or unique outcome?

Review Questions

According to Nardone, what is the first ethical stance of the constructive therapist?

What does the treatment outcome research say about the efficacy of solution-based and narrative therapies?