A Comparison of Viewpoints: Finding truth in constructivist psychotherapy
 
Matt Coble

Science is a construction of the human mind. The theories, approaches, and methods that are used in any scientific field have gradually developed over time to become an objective standard of evaluation. As science continues to evolve, new approaches to obtaining knowledge about the world around us must be considered, and at the same time these new approaches must be evaluated within the present context of what is considered to be science. In doing so, conflict and confusion will arise as new concepts meet the critical evaluation of the old. The appraisal of and criticism of a new approach to psychological therapy is one example of such a situation. By looking at the evaluation of constructivist psychotherapy, one can bring this conflict and confusion into the light of understanding.

Since its dawning at the turn of the century, psychotherapy has faced a myriad of objections in regard to its validity as a scientific practice. With the introduction of psychoanalysis in the late 1800’s, Freud opened the doors to a field that would mature as the next one hundred years progressed. Throughout its evolution, psychotherapy has been evaluated for its capacity to deal with clients on an individual basis and at the same time maintain the objective viewpoint which science requires. In what Robert Neimeyer considers a "postmodern context" of scientific, social and political themes, a new philosophical approach to psychotherapy has developed. This approach, called constructivism, is based on a subjective interpretation of reality and how that interpretation affects human thought processes. In "An Appraisal of Constructivist Psychotherapies", Neimeyer looks at how constructivism has developed in psychotherapy, how it has diverged into various sub-fields, what valuable contributions it brings to the ever-advancing field, and finally what problems lie in this subjective approach.

In the article titled "Constructivism in Psychotherapy: Truth and Consequences," Professor Barbara Held criticizes the constructivist approach for its antirealist claims. She reasons that the subjective nature of constructivist therapy disallows the knower from coming to any conclusions that are founded on an independent, objective reality. Rather, "knowers make, invent, constitute, create, construct, or narrate, in language, their own subjective realities…".1 In her analysis of this alternative method of psychotherapy, Held takes a straightforward, logical approach that leads her to conclude that constructivism is not an acceptable, standardized means of therapy. She walks the reader through the distinctions between realism and antirealism, the consequences of yielding to subjective therapy, and evidence that such therapy does appeal to antirealist doctrine. However, she oversimplifies the true essence of contructivist psychotherapy. By reducing it to the absurd she does not give a full view of the complexity that is involved in this relatively new therapy.

Modern psychology branches out into a variety of therapeutic approaches. The "classical" approaches, such as cognitive theories, developed as a result of a highly analytic/empirical philosophy embedded in the foundations of modern science. Therapists of these schools of thought maintain that there is an outside, objective reality that can be used as a reference point, or standard, in measuring their clients’ internal world. It is certainly reasonable to assume that purely objective measures would benefit any means of personal evaluation. Within the past twenty years, however, a new approach in psychotherapy has gained precedence among the shadows of traditional cognitive therapy. The constructivist viewpoint carries with it a certain degree of subjectivity in that it emphasizes the self-organizing features of knowing and operates on the principle that human knowledge is interpersonal and evolutionary.2

It should be remembered that constructivism is more a philosophy than a set of therapeutic guidelines. This point is made clear initially by Neimeyer, who offers the following statement in his introductory paragraph: "Constructivist therapy is not so much a technique as a philosophical context within which therapy is done, and more a product of the zeitgeist than the brainchild of any single theorist."3 According to this author, constructivist movement is a direct result of the postmodern culture in which all of academia currently finds itself. Just what does this "postmodern culture" entail? Neimeyer suggests that it involves a new social consciousness that recognizes that there are many different belief systems and apparent realities that are not necessarily absolute, but rather socially constructed.4 The philosophical nature of the constructivist approach is an obvious movement away from the objective scientific approach. Furthermore, constructivist psychotherapy represent a movement away from traditional cognitive approaches that are based on scientific objectivity.

There has been an increasing amount of evidence that supports the effectiveness of constructivist psychotherapy. Studies following classical cognitive approaches have yielded positive results for new methods of therapy. For example, the hypothesis that personal constructions ultimately frame distinctions that operate as tools for subjectively categorizing experience, decision processes, and controlling behavior has received support in many studies that use procedures that have been developed in the cognitive sciences.5

Neimeyer argues that the postmodern way of thinking requires us to develop a new standard of evaluation, one which is not so sternly grounded in the highly rational, highly logical nature of science. As human knowledge continues to evolve, so has our means of coming to understand and collect this knowledge. The author feels that current trends in the intellectual world are giving rise to a new wave of critical evaluation. He notes that "Late 20th century philosophers of science have redefined the concept of rationality to give greater priority to the preservation of central theoretical concepts than to their immediate rejection when they fail to square with the facts."6 As knowledge of our surroundings continues to evolve, so must the approach to how we interpret that knowledge.

Cognitive therapists often look at the perceptions of reality that their patients have and compare that to what they (therapists) consider to be an objective reality. How well these perceptions match up with what is "real" is used as an initial evaluation of the client’s cognitive processes. The goal of the therapist, then, is to eliminate any irrational, self-constructed concepts that may be causing the client’s distress. Neimeyer believes that in a multi-cultural society such as ours, psychological therapy systems should not use these "reality checks" as a standard for treatment. He says that, "the very pluralism of beliefs in the postmodern world challenges the credibility of any psychological system that equates adjustment with accuracy of reality contact."7 Furthermore, he refers to Anderson who states in his book, Reality isn't what it used to be, that "It is very hard, in a world with many realities, [italics added] to maintain the position that satisfactory adjustment to one reality is equivalent to mental health, and that unsatisfactory adjustment is a form of mental illness."8 It should be mentioned here that throughout the article, Neimeyer, along with others, refer to the existence of "multiple realities." He never clearly defines this concept and in turn does not provide as precise a definition of constructivism as he may have been able to. Whether this term implies actual physical realities or merely varying perceptions of one reality is rather ambiguous. While certainly there is a difference between these two interpretations, the distinction is not made in the article.

It is certainly possible that this distinction is required if constructivist psychotherapy is to gain acceptance among the traditional methods of cognitive psychological therapy. As the field of psychology has evolved, the theorists and clinicians have gone through a mass of critical evaluations by the rest of the scientific community in order to determine the objective validity of their work. Psychology has worked hard to become a science, and it is not going to accept methods that dabble into "multiple realities." It is certainly reasonable to understand why psychologists such as Barbara Held are skeptical of constructivist therapy.

Held finds a logical inconsistency in the constructivist approach. Her arguments are centered on the antirealist doctrine, which according to her is a philosophy that constructivist therapists promote. The antirealist approach assumes that knowledge of an objective reality, independent of the knower, is impossible. It is when the constructivist therapists evaluate their own work that Held sees an illogical contradiction in this approach: "Despite their professed antirealism, constructivist/constructionist therapists make-as they must and as they should-general reality or truth claims about the effectiveness of their therapy."9 According to the critic, there is no way for such therapists to step back and look at their own progress in an objective manner as long as they promote subjectivism in their practices.

It is possible, however, that in her analysis Held has forced constructivist therapy into the context of antirealism. As Neimeyer suggests, constructivist therapists regard knowledge as a hierarchical, self-organized system. Through one's own personal experience, knowledge is obtained through selective processes and adaptations. Thus, knowledge is considered to be an evolution through a more comprehensive set of interpretations.10 This does not necessarily mean that all knowledge of reality is first sifted through subjective experience, but rather that it is open to multiple interpretations. Neimeyer states that "The goal of constructivist therapists is ultimately more creative than corrective, insofar as they attempt to foster the broader development of the client's constructions rather than eliminate or revise cognitive distortions."11 Creativity, interpretation, and evolution of self-knowledge are characteristics that go hand in hand with constructivist therapy and the phenomenological perspective from which it derives. Once again this seems to create problems for Held, who argues that from this perspective the only reality that a person will have is that which he creates, or "constructs" through this form of therapy.

One of the characteristics of the constructivist approach, according to Neimeyer, is that of active knowing. The knower (or patient) is able to be proactive and goal-directive in his or her own reflections of personal experience. As a result, the therapist plays a reflective role, one that is more interpersonal than that of the classical cognitive therapist. The traditional therapeutic methods of therapy require the therapist to be more instructive and authoritative, thus giving the patient a more passive perspective in his or her own treatment.

Constructivists do not view active knowledge as being problematic in therapy, and apparently neither does Held. In her statement that "the idea of an active rather than a passive knower is falsely assumed to imply antirealism."12, she is trying to make the point that constructivist therapists falsely assume that active knowing leads to antirealist claims. However, the contructivist therapists do not consider their approach as antirealistic, but rather it is Held who holds this belief. It seems that in making this statement, Held contradicts herself by allowing her own terminology to invade the viewpoints of others.

It seems that misunderstanding and misjudgement are at the center of the controversy between traditional cognitive approaches and constructivist approaches to psychotherapy. There must be a more clear understanding of what it means to construct subjective realities and partake in active knowing before either viewpoint is criticized. This can only be done when therapists first look inward at their own approaches and evaluate them as objectively as possible. Furthermore, perhaps it is time for the field of psychology as a whole to re-evaluate what methods of therapy are effective and what standards will be used to measure this effectiveness. As the field continues to evolve, perhaps so should its standards of performance. Like any other science, adaptation is essential for the continuation of interpretive knowledge.

One must look no further than the revolution in quantum physics that occurred at the beginning half of this century. The world of classical Newtonian physics was turned upside down and inside out with the arrival of a new class of physicists and astronomers. At the head of that class was a young German scientist named Einstein, who with his theory of relativity redefined our concept of mass, energy, and the like. Now that we bring the second half of this century to a close, perhaps psychology is also ready for such a revolution. Certainly, parallels can be made to what is currently going on in the world of psychotherapy. New approaches are developing under the influence of a changing social conscience. The classical approaches to patient therapy revolve around traditional cognitive perspectives, which follow a linear, systematic set of guidelines. The constructivist approach to is a much more complex, yet encompassing form of psychotherapy that deserves continual exploration.