Constructivist Psychotherapy

Constructivism refers to a group of theories (originally stemming from George Kelly's personal construct theory) holding the philosophical position that so-called reality is, in some ways, created by persons. Rather than imposing some objective truth on persons seeking help, constructivist therapists attempt experientially to grasp the lived reality of each client. Constructivist therapy is a cocreated experience between therapist and client, mutual experts on different aspects of the reality being created between them. This relationship is more egalitarian and client-empowering than approaches in which the more powerful therapist imposes diagnostic and treatment "realities" on the less powerful client. Consistent with Kelly's theory, constructivist psychotherapy can be seen as a part of the broader group of humanistic, existential, and postmodern therapies.

While all constructivists agree that reality cannot be known directly, different theoretical groups disagree on the exact nature of the relationship between the person and the world. Radical constructivists argue that one cannot even speak of a reality outside of the meanings the person has created. Social constructionists might argue that we are saturated with meanings created by cultures and imposed upon us. Occupying a middle ground, critical constructivists believe that meanings are cocreated in the dynamic interaction between the person and the world.

Although there are numerous specific approaches (a few of which are described later), constructivist therapies generally share certain attitudes about therapy. Most con-structivists will listen to clients with the assumption that everything the client says is true in the sense of revealing important aspects of the client's experiential meaning system (Kelly's credulous approach). There is a respect for contrast, oppositionality, or the dialectic in meaning making. Most constructivists also are attuned to making therapy a safe place for clients to experience life, explore, and grow, and they emphasize seeing the client as a process of meaning creation rather than a static entity composed of specific meanings. The client's process of construction is seen as active as opposed to reactive and underscores the agency of the person, again emphasizing the humanistic and existential roots of the approach.

Different constructivist therapists employ these attitudes in different therapeutic approaches. In Kelly's fixed-role therapy, for example, the client first writes a character sketch that is open, revealing, yet sympathetic. This sketch is written in the third person, from the perspective of a friend who might know the client most intimately. The therapist and client then cocreate an alternate sketch for the client to enact, typically for a 2-week period. Fixed-role therapy is viewed as a failure if the client sees it as a behavioral prescription; it is designed to free the client to experiment with alternative ways of experiencing life.

Experiential personal construct psychotherapy (EPCP) is based upon the relational, experiential, and existential foundations of personal construct psychology. EPCP construes persons as simultaneously needing and being terrified of depths of emotional closeness. On the one hand, such intimate relationships can affirm the meanings that have formed the foundation of our existence. On the other hand, we can experience devastating disconfirmation in intimate relationships. Clients then struggle with needing to connect with others, risking terror to gain profound richness, versus retreating from intimacy, buying safety at the cost of the empty objectification of self and others. Therapeutic growth can occur if the therapist experiences optimal therapeutic distance, a blending of profound connection and separateness, when the therapist is close enough to feel the client's experience yet distant enough to recognize those feelings as the client's and not the therapist's own.

Other constructivist therapists employ narrative approaches to therapy. These therapists believe that narra tives give meaning and continuity to the lived experience of clients. Gaps, incompleteness, and incoherence in the client's life story may indicate struggles in creating an integrated experience of self-in-the-world. Goncalves illustrates constructivist narrative therapy with his "moviola" technique, in which the therapist's attention scans the settings of a client's life, much like a camera in a movie. The therapist can zoom in on a detail or back off and get a more panoramic view. For example, a therapist might start by having the client describe the entire room in which he or she was abused. Eventually, the therapist might help the client see in detail his or her face, filled with fear and horror, while the abuse occurred. Because people innately create meanings to understand their experiences, the experience of re-viewing the abuse with an empathic therapist allows for new constructions to be created. These newer meanings, in turn, allow for newer experiences as clients' lives move into the future.

Depth-oriented brief therapy (DOBT) applies construc-tivist principles to help clients understand and engage in radical change in a very short-term treatment. DOBT understands the symptom as painful because of the ways it invalidates important aspects of our experience. At the same time, there are other constructions, often at a lower level of consciousness, making the symptom absolutely necessary for the client. DOBT uses specific experiential techniques to help the client gain access to these deeper meanings. The client then can more consciously decide whether to keep or abandon these more unconscious meanings.

Constructivist therapy has been used with a wide range of problems, from mild adjustment issues to the most severely disturbed clients. It has been used with specific symptoms (e.g., stuttering, obesity, bulimia, posttraumatic flashbacks) as well as more general life distress. It also has been useful with young children as well as elderly clients. Specific constructivist techniques have been developed for family therapy (e.g., systemic bow-ties to help each client understand how their actions, based upon their deepest fears, confirm the deepest fears of other family members).

There have been numerous methodologically sound studies exploring the effectiveness of constructivist therapies across different countries, ages, and types of problems. Effect sizes for client change in these studies were at least as large as those reported in the cognitive-behavioral and psychoanalytic literature. In other words, good construc-tivist therapy respects the lived experiences of persons and has been empirically supported by studies that meet the most rigorous of experimental criteria.

D. J. Domenici

Miami University

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