Therapeutic Heresies: A relational constructionist approach to psychotherapy

8/12/2019 Therapeutic Heresies: A relational constructionist approach to psychotherapy

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LFTRC & AIA Volume No 21, Issue 3, 2010, pp. 420-443

Human Systems: The Journal of Therapy, Consultation & Training

Therapeutic Heresies:A Relational-Constructionist Approach to

Psychotherapy

Edgardo Morales-ArandesAssistant Professor at the Psychology Department

of the University of Puerto RicoRo Piedras Campus.

Tis article presents a Relational Constructionist approach

to psychotherapy. It describes how the key assumptions oRelational Constructionism can serve as a generative rameworkto engage psychotherapy, question and reimagine its practicesand traditions and release the creativity and imagination o itsparticipants. Trough the use o stories, narratives, and personalreections, three modalities o relational practices are presentedas a way to illustrate the generative possibilities o therapeuticdialogue rom a relational constructionist perspective. Tesethree modalities: Opening a dialogical space, co-creating andacknowledging competencies and abilities and generating acrisis o aith are provided as examples o the many dialogicoptions that therapists may access when they relate rom astance that acknowledges the participatory, relational and co-constructed nature o reality. Tey also demonstrate how throughthe acknowledgement o multiple voices and perspectives andthe use o conversational resources such as listening, metaphor,humor, storytelling and improvisation client and therapistcan collaborate together to question and destabilize dominantproblem saturated stories and co-create alternative and morehope ul utures that make new meanings and courses o actionpossible.

Key words: Relational constructionism, co-construction, notknowing, relational practices, therapeutic change

Relational constructionism begins with a simple but important idea: everythingwe consider real, all the truths that we cherish and the values we hold are


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Therapeutic Heresies: A Relational-Construtionist Approach to Psychotherapy 421

constructed in and through the web o relationships that we participate in.When applying this idea to psychotherapy, we are invited to re-imagine and

question its practices and traditions, particularly those that have operated asunexamined truths or as a oundational logic in the discipline. Tis approachto psychotherapy may be considered a heresy when compared to traditionaltheories and models that through their rigid standards and orthodoxies, andclaims to objectivity and knowledge, have imposed an institutional orderconstraining the imaginative possibilities o therapeutic practice. In thispaper, I wish to explore the ways through which relational constructionismcan help to release our imagination and creativity as psychotherapists. In it,I will make re erence to the controversies, tensions, and uncertainty that are

present within our practice and within our discourses. I will also suggest a view o psychotherapy that sees therapist and client, as active co-participantsin constructing the realities that emerge during the psychotherapeutic process.Tis approach stresses the importance o using conversational resources suchas humor, curiosity, listening, metaphor, storytelling and improvisation, as away to explore a clients narrative and generate new possibilities or meaningand action in his or her li e.

Several o these conversational resources will also be included in the tellingo my story o relational constructionism and psychotherapy. I includepersonal narratives, reections and conversations with others, as part o mytale. Hope ully, this will enable a dialogue with the reader that may enrich anddeepen his or her understanding o the ideas that will be discussed. I beginwith a personal story.

Discarding FlowersMore than thirty years ago, I began my clinical practice as a psychosocialtechnician in a mental health center in Puerto Rico, where I was expectedto lead group, couple and individual therapy. I had recently graduated with abachelors degree in psychology and had ew other qualications to per ormpsychotherapy, other than general readings in psychology and my ownexperiences as a client.

I met my rst client lled with anticipation and anxiety. She was a 30-year-oldwoman who entered my office crying, anxious and concerned about the utureo her marriage. She was convinced that her husband no longer loved her andcame to therapy in order to prepare hersel emotionally or what she believedwould be the eventual break up o her relationship.


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Edgardo Morales-Arandes422 Human Systems

She told me she had been married or over a year and that she was deeply inlove with her husband. She was distraught because his behavior during the

last several months appeared to indicate that he was disinterested in theirmarriage. Tis, according to her, contrasted with his actions during the monthsthat immediately ollowed their wedding. During that time, he seemed to bedeeply in love with her. He called her at work several times a day and sent hera bouquet o owers three or our times a week.

As she sobbed, she sadly stated that he was now a changed person. His callsshe said, had become less requent and now he called her only once a day.She paused and spoke sadly as her eyes swelled with tears, Now, I only receive

owers once a week. I asked her, i she had shared her concerns with herhusband. She answered yes, and indicated that when con ronted with herdoubts, he insisted that he loved her as much as be ore. His strong denial, sheclaimed, just served to increase her distrust.

I proceeded to ask her general questions about her relationship. She insistedthat they had no major conicts and until recently, she had enjoyed the timeshe spent with her husband, as well as their sexual relationship. She reiterated,however, that because o the change in his behavior, she was a raid thatsomething terrible was going to happen to their marriage, and that this madeher eel strange and distant rom him.

Listening to her story, I was somewhat perplexed and unsure on how toproceed. Looking or some kind o opening, I decided to ask her about herli e and work environment. Her sobbing decreased as she described her job asa secretary and how much she enjoyed it. She also spoke o her many emaleriends at work. I asked her i they were married and i they elt loved by theirhusbands. She answered in the affirmative, and added that she knew this,because the quality o their relationships with their husbands had been a topico conversation during her rst months o marriage.

As I heard this last comment, I heard the voice o my own therapist resonatingwithin with the questions he usually asked when I shared a particular story.Ten, something changed inside me, I paused or a second and attempting toappear con used and perplexed asked her, And what do they do with all theowers in your office? My client was momentarily stunned by my questionand answered, I dont understand. What do you mean? I responded, Well,i your co-workers have wonder ul relationships with their husbands, then Isuppose your office must be ooded by telephone calls and the owers that


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they send daily to their wives. I imagine that theres a serious problem withorganizing and discarding them. It must be a ull blown operation, and I

thought that in your office someone had gured out some novel solution orthis. I was just wondering how they did it. For a moment, she seemed moreperplexed than be ore. Ten a slight smile appeared on her ace be ore sheasked me, Are you kidding? I answered, No, Im very serious about this. Ivethought about working as an organizational consultant and the solution mightbe help ul to me in the uture. She stared at me or a second and then beganlaughing. Ten, she asked me, Are you trying to tell me that Im worryingneedlessly that my husband, as well as other husbands, has his own wayo expressing his love? o which I answered, Well, I dont know i thats the

case, but what I think really doesnt matter; what matters is what you believe.What do you think?

From that moment on, the tempo o the conversation changed. We began toreect together on the events and meanings o her initial story. We exploredwhether there were any other reasons that would lead her to worry about herrelationship with her husband and i there were conversations with him thatshe needed to engage in. We talked about her dreams or her relationship,her pro essional goals, and the importance o communicating and affirminghersel in her li e. When the session was nished, she thanked me and toldme that she would contact me i necessary. I never saw her again. A couple omonths later I received a letter thanking me or my services.

Trough the years I have shared this story with students and colleagues.Te responses have been varied. Some have been surprised by the ingenuityand the luck o a novice therapist. Others have been more critical. Teyvequestioned a therapeutic strategy that did not diagnose the disorder thatthe client suffered. Tis, theyve reminded me, should have been one o mypriorities. Several colleagues o a more cognitive persuasion have argued that Ishould have been more systematic in my approach, helping her to identi y hercognitive distortions and teaching her to substitute them with more rationalways o thinking. Others have thought that my approach was too supercial.Problems like the one she portrayed, theyve claimed, are ofen indicative oa complex disorder. Teyve suggested that her obsessive preoccupation withthe loss o her husbands love unctioned as a symbolic representation o anunresolved psychic conict with her ather. Tey pointed out that what I didprobably just helped to suppress a symptom that would reappear in the uture,perhaps in a more virulent ashion, since what caused it in the rst place hadnot been resolved.


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Each advice that I heard, i applied, would have taken my conversation withher in a totally different direction. It would have produced different questions

and interpretations. A new story would have probably emerged. What wouldhave been considered important, signicant, or problematic, would have beendened differently according to the personal and theoretical ramework whichI would have utilized.

Tis anecdote and the responses to it, points to the multiple ways that therapistand client participate in the constructions o the realities they encounterin psychotherapy. It illustrates how what we as therapists listen and seem todiscover in psychotherapy are not de-contextualized realities or stories. We

co-create them with our clients through the way our conversations, bodylanguage, dramatic and emotional expressions, questions, affirmations, andsilences construct a conversational dance through which a clients story istold and heard.

Relational Constructionism

Tis view o psychotherapy as a place where stories are co-created is oundedon a relational and constructionist concept o social reality. Tis approachstresses that meaning doesnt lie inside or outside the individual, but ratherdevelops in and through our relationships with others. It affirms that what weknow, and our ethics and morals are constructed through our participationin the social world and the communities and traditions to which we belong.It sees human beings as active agents who construct the social realities inwhich they participate. Tese constructed realities guide and provide meaningto ones own actions and the actions o others (Botella, 2006; Gergen, 2007;Hosking, 2007).

From the perspective o relational constructionism, stories and narrativesare the means used by human beings to generate meaning. Tey serve toconstruct order in a changing and sometimes chaotic world where a clearcourse o action is not always evident. Stories and narratives give substance toour experiences, placing and organizing them in temporal space. Tey help usto explain events, to relate one experience to another, while generating a senseo coherence and continuity in our lives (Cotter, Asher, Levin & Caplan, 2004;Botella, 2006).

Our stories are constantly evolving and changing according to the ongoing

experiences and relationships in our li e. Tere is not one story or narrative that


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denes us or that is permanently static and xed in time (Cottor et al, 2004).Tey are not products o isolated selves but instead, are social creations that are

generated through the relational networks that we maintain throughout ourlives. Each story requires a narrator and an audience that listens and respondsto it. Te dynamic relationship between narrator, narrative, and audiencetrans orms a particular narrative and converts it into a co-created productand a orm o relationship through which we generate meaning and elaboratea particular social identity (McLeod, 1997).

Te sel appears as another character in the collection o stories which wenarrate. It emerges as a construction that is produced and reproduced in the

context o the multiple relationships in which we engage. For the perspective orelational constructionism there is no such thing as a xed sel , or a particularessence that denes the individual sel . Instead, the sel is seen as acommunity o selves that emerges through our relationship and participationin different social contexts. Tere ore, it cant be said that we speak rom oneidentity and through one voice. We are all comprised o various voices thatreect our participation in different social and relational contexts, voices that;i not identical do congure a polyphony that contributes to the nal product(Botella, 2006, p. 30). As poly-vocal beings, we have the capacity to speak withdifferent voices, rom multiple perspectives and points o views.

Tese assumptions about the sel are not proclaimed as a new truth. Doingso would be contrary to the ideas held by relational constructionism, sinceit would presuppose that an objective reality exists that can be grasped andunderstood by a set o concepts and practices that operate independentlyo their historical and social contexts. Instead, relational constructionismassumes that when a new truth is proclaimed and a given course o action isseen as morally correct, it reects a particular cultural tradition in the contexto a specic orm o relationship or way o li e (Gergen, 2007).

Assuming that reality is relationally constructed, does not preclude advocating values and positions or proposing rules and guidelines to coordinate actionsand regulate human activity. When engaging others we need to speak, chooseand act to satis y shared and personal interests, as well as address controversies,dilemmas, and conicts that may be part o social discourse and interaction.Our actions, however, can be tempered by the understanding that any value ordeclared truth is situated in a particular historical and communal context andthere ore, there is no ideology, tradition, or way o knowing that represents auniversal truth or has an intrinsic normative power.


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Tis stance promotes what Gergen and Gergen (2004) have called a radicalpluralism, an openness in the social discourse to the multiple orms in which

we can value or attribute meaning. Radical pluralism rees us rom the need todecide which tradition, ideology, or ethical or moral proposal represents thetruth. It avors social practices based on dialogue and respect or diversity. Italso promotes the emergence o discordant voices, and the curiosity to exploreand understand the role that these play in the communities and traditionsrom which they emerge.

Relational constructionism invites us to pragmatically and critically reecton our everyday lives, on the values we hold and the actions we take. In a

constructed world, any action or belie is seen as only one way, amongstmany, o engaging or valuing social reality. Tere ore, rather than evaluatingwhether a specic argument or pronouncement is true (that is, i it is a preciserepresentation o reality), it avors examining the implications o what is beingadvocated. We can ask ourselves, or example, what practices or bodies oknowledge are privileged and which are being suppressed or marginalizedby the truth Im being asked to hold? We can question what traditions arehonored and which are being discarded in what is being promoted by what isbeing said or by what is being written? We can also reect on the world thatis being created by a particular social discourse and whether it is the type oworld we would want to live in. (Gergen and Gergen, 2004).

Tis stance towards living promotes a type o sensibility and social practice thatsharpens our critical awareness and generates new possibilities or dialogueand social coexistence. It provides a generative ramework or exploring andenriching our capacity to understand and take action in the midst o a poly- vocal world (Gergen & Gergen, 2004; Botella, 2006).

Psychotherapy and Relational ConstructionismRelational constructionism is not a model or doing psychotherapy. Instead,it proposes a stance or engaging psychotherapy. It invites us to rethinkand reconsider the practice and traditions o psychotherapy, as well as theways through which the realities that clients and patients experience areco-constructed during the psychotherapeutic encounter. In rethinkingpsychotherapy, it also seeks to challenge taking or granted practices thatrestrict the capacity o its participants to per orm sensitive, spontaneous and/or regenerative action.


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For example, a core component o modern psychotherapy is the practice odiagnosis. Diagnosis has been seen as a necessary step or understanding

and explaining a clients problems and or designing and initiating treatmentplans. Its terminology has been sanctioned by the managed care system and isrequired or billing. As a social practice, it positions the therapist as an expertobserver, tasked with questioning and examining a client (who is assumedto be in some way decient in need o help), in order to comply with a pre-established agenda o locating the individuals dys unctional condition withina set o pre-established categories.

Diagnosis may com ort a particular client because it may provide him or her

with the hope that by naming a clinical condition, a problem has been identiedand a treatment leading to a solution can be implemented. However, rom arelational constructionist perspective there is much to challenge and questionregarding the unexamined assumptions o its practice, as well as the view thatit purports o psychotherapy and the psychotherapeutic relationship.

Diagnosis is part o the modernist tradition in psychotherapy. It assumesthat there is a truth value in the assertions o those that are thought o asobjective observers. In its attempt to mimic the medical sciences, it holds thathuman action and experience, like biomedical conditions, can be explainedand predicted through observation and the mapping o cause and effectrelationships, In doing so, it locates the causes o dys unctions within theindividual, thus, negating the impact o social context and discourse on aclients narrative and lived experience (Gergen, Hoffman & Anderson, 1996).

Relational constructionism assumes that psychotherapy is a particular typeo relationship that is embedded within a specic cultural and pro essionaltradition and discourse. It also supposes that the way this relationship isramed and per ormed by its participants generate the realities that are livedand experienced during the psychotherapeutic process. When one viewsthe practice o diagnosis rom this perspective, one can begin to exploreand question the degree to which the hierarchical nature o the diagnosticrelationship, where one participant stands rom a position o institutionalizedpower in judgment o the other, shapes the relationship between them andinuences the realities that are being described and categorized.

With its medical jargon and deciency based language, diagnostic discoursehas served to privilege a view o social li e that stigmatizes personal identity.It is a discourse based on incapacity and illness. In this manner, it constructs


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a relational world in which the persons deciency is the main topic oconversations in therapy and his or her principal reality. Tis practice, taken to

its extreme, blends the client and his or her problem into one single entity: thepsychological disorder. Tis in turn rein orces the persons idea that not only issomething wrong, but that which is wrong in the client is him or hersel .

A diagnosis can also bestow a social identity based on dys unction andincapacity. In as much as its language has penetrated social discourse and hasbeen disseminated throughout society, it has created a population o consumerso psychological services that demand the intervention o knowledgeablepro essionals to provide appropriate cures (Gergen, et al. 1996).

Te practice o diagnosis has served to reaffirm the idea that psychotherapy isa techno-medical project where a human being is a machine and the therapista technician that works with aulty human machinery (Anderson, 1997,p. 67). In doing so, it has contributed to a discourse that seeks to eliminateuncertainty and inventiveness rom the practice o psychotherapy and is inpart responsible, or the recent trend in psychology that has insisted thatall psychological practice be based on empirical data gathered through theimplementation o experimental clinical trials. Tis stance has privileged theuse o manuals and standardized procedures to treat specic li e problems andmental disorders, as they appear in the DSM-IV.

Relational Constructionism positions itsel against attempts to standardizeand homogenize the practice o psychotherapy. In doing so, it proposes a viewo diagnostic practice that considers it as just another relational move withinthe context o a social relationship, which we call psychotherapy. It also seesit as a mode o languaging a particular orm o relationship which has beenlegitimized within the context o a specic pro essional tradition. It questionsthe truth o the assertions and methodology used to produce diagnosticcategories and locate clients within them. In questioning the practice odiagnosis, a relational constructionist stance examines the kind o identitiesand social relationships that are created through the diagnostic discourse andwhether the therapeutic realities that it generates lead to more engaging andullling lives, or those labeled (Gergen, 2005).

Relational constructionism rees us to re-imagine the practice o psychotherapyand explore the possibilities generated by our images o its practice. We need nolonger to think o it as a treatment, a scientic procedure or a place to acquirean experts knowledge. Instead, we are invited to envision psychotherapy


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in more relational ways, as a orm o dialogue or conversation that aims toexpand the resources available to the client, so as to enable and generate new

histories, realities, and possibilities o action and meaning (Gergen, 2005;Botella, 2006).

Tis approach proposes that there are no particular standardized practices orprocedures that need to be ollowed or a specic identity that the therapistneeds to assume. In this sense, what a therapist does and who he or she is,can take different orms according to the particular relationship that he or sheestablishes with a client. In addition, therapist and client collaborate togetherin dening and negotiating the purpose and goals o their relationship.

Tey each enter the therapeutic encounter with different kinds o expertisein specic domains in their personal and social li e. Te client in particular,can be seen as possessing important knowledge that enables him or her toevaluate and decide what is meaning ul and what to share within the contexto psychotherapy (Anderson, 2007).

Living in a constructed world rees psychotherapists rom the burden ohaving to determine whether the assertions made by a particular model odoing psychotherapy are true or not. Instead, it generates openness towardsthe use o diverse methods and/or psychotherapeutic languages that may servethe aims o the therapeutic encounter (Elkaim, 1997). Tis means that ratherthan engaging psychotherapy rom a stance that prescribes a set o techniques,or a xed position or identity rom which to act, it approaches it with a morepragmatic orientation. It examines the consequences that different orms orelationships and the conversational moves o each o the participants have onthe therapeutic process. In this sense, all actions are open to review. Insteado re erring to theoretical cannon in order to determine how to proceed, atherapist may choose to examine the effectiveness o his or her actions. He canexplore, or example, whether they have potentiated or hindered dialogue ororms o li e that support the negotiated purpose o psychotherapy.

In regards to the clients discourse, relational constructionism assumesthat a particular narrative does not represent a literal truth but instead, is acontingent construction in whose creation client and therapist participate.It also contends that the stories that are initially told in psychotherapy arenot the only ones capable o being spoken. Tis implies that the official story,the one that generates and conrms a clients problematic identity and whichis ofen saturated with difficulties and hopelessness, is only one amongstmultiple narratives that a person may use to signi y his or her li e. Viewed


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rom this perspective, the therapeutic relationship becomes the context wherenew alternative and hope ul stories may be co-created. Tey may be built rom

voices that have been suppressed or ignored and that hold within them thecapacity to make new meanings and courses o action possible (Gergen, 2005;White, 2007).

Te creation o new narratives and resources or action is generated inthe context o a conversational process that ofen places the therapist in anot-knowing position and requires what has been called in Zen practice,a dont know or beginners mind. Tis is a type o a relational presencethat acknowledges the uncertainty inherent in li e and which seeks to ace

any situation with openness and without attachment to preconceived ideas,interpretations, or judgements (Suzuki, 1973; Mitchell, 1976).

In the context o psychotherapy a stance o not knowing implies, amongother things, an acknowledgement that its participants cannot predict withcertainty the path that will be taken as a conversation proceeds. How someonewill respond to a particular conversational move can never be predicted withabsolute certainty. How conversational moves are interpreted, redirect theconversational dance in psychotherapy in different and ofen unexpecteddirections.

Not knowing, there ore, implies living with uncertainty and becomingsensible to what McNamee (2003) describes as the interactive moment. Itbecomes a relational space where therapist and client become equals, becauseneither knows how each succeeding moment in psychotherapy will un old. Itis also the place where psychotherapy becomes art, where the therapist hasthe opportunity to use his or her imagination and intuition to improvise andexplore different opportunities and options o relating and interaction. It isa moment where one can listen to the different voices that serve as internalcompanions ( riends, mentors, therapeutic models, amily, colleagues,alternate identities) and make use o available conversational resourcesto deepen the dialogue and generate un oreseen paths in the therapeuticrelationship (McNamee, 2003).

In summary, a therapy in ormed by a relational constructionist sensibility,positions the therapist in a reexive and open relationship to the practice andtraditions o psychotherapy and allows him or her to explore the conversationalpossibilities inherent in the therapeutic dialogue. It cultivates a presence thatincludes and acknowledges multiple voices, perspectives and identities in


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therapist and client, and uses them as dialogic resources that can enable a clientto deconstruct what is problematic and re-imagine that which is possible.

Relational Practices

I have outlined the implications o approaching psychotherapy rom arelational-constructionist sensibility. I now wish to examine three modalitieso relational practice that illustrate the possibilities o action that it can generatein psychotherapy.

Opening a Dialogical Space

A rst group o relational practices have as their aim the creation o an openended dialogical space in the client-therapist relationship that enables a processo shared inquiry to occur. Tis space is generated in part, through the practiceo deep and sensitive listening that brings a sense o curiosity and an interestin capturing and understanding the clients experiences and narratives in theirull complexity. Listening includes and transcends the ability to quietly payattention. It implies a way o inquiring, representing and dramatizing what hasbeen grasped in ways that reverberate with the elt experience o the client andis recognized by him or her as an accurate depiction o his or her experience.

Synchronizing and paying attention to different dimensions o language andhuman communication may also help to generate a dialogical space. Tis maymean, or example, becoming aware o the way in which the client makes useo corporal expressions, gestures, movements and modulates his or her voiceto communicate and signi y his or her experience. Tis sensibility allows thetherapist to synchronize and adapt his or her communication to the spokenand unspoken language and rhythms o the client. It also allows him or her tostep into a persons shoes, imagine the world rom the clients perspective, andrepresent dramatically and with eeling the experience o the client so as todemonstrate that he has grasped his or her story in its ull complexity.

Conversational resources such as drama and metaphor may be used in theservice o connecting with the elt experience o the client and creating acontext where client and therapist can begin to relationally engage witheach other. Tey can become use ul tools o relating and moving into theexperiential world o the client in ways that can engage him or her and openup the possibilities o dialogue.


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Te Cat WomanSeveral years ago, a young, 18-year-old woman, who had been diagnosed as a

paranoid schizophrenic, was re erred to me. Her prior therapist had in ormedme that the woman heard voices and, on occasion, had acted aggressively inher home, using scissors to cut and shred her clothing in ront o her amazedparents. He also claimed that she had been an unwilling and unresponsiveparticipant in psychotherapy. According to him, her only meaning ulrelationship was with a small white cat that she played with and talked to athome.

Te young woman arrived with her parents at the community mental health

center where I worked. She entered alone into my office and sat in a chairbeside a desk in the room. As she sat, I was able to notice how her make-upintensied the paleness o her skin and contrasted with the intense redness oher lips. Her gaze was xed but seemed lost in space. Tis made me wonderhow I was going to approach and engage her in conversation. I began with theintroductory rituals which are common in our pro ession. I stated my interestin talking with her and helping her. I asked her or her name, the reason shehad come to my office, and whether there were any concerns that she would beinterested in sharing with me. She responded to each question with silence andan immutable physical expression. During the next ew minutes, I attempteddifferent strategies to initiate a dialogue but all o them ailed. She remainedresolute in her re usal to engage me in a meaning ul conversation.

I elt rustrated and con used, with ew ideas on how to proceed. Ten, Iremembered the words o her ormer therapist and his comment about herrelationship with her cat. At this point, I changed the tone o my voice andsofly mentioned that like her, I had a small pet kitten. o my surprise, her righteyebrow lifed. For the rst time, I had received a response that recognized mypresence in the conversation!

I decided to continue talking about the kitten. I described some o his habitsand personality traits. She responded to each piece o additional in ormationwith a change in her acial expression which I interpreted as a sign o interestand curiosity in what I was sharing. I then decided to take a risk. I mentionedwith excitement, that my kitten was very mischievous and had a habit ointerrupting me in the most inopportune moments. For example, I told her,this morning, while I was doing my homework at my desk, the kitten camenear to where I was sitting, looked at me with his big eyes and you knowwhat he did? I paused or a second and then, suddenly, I jumped on top o


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the desk. I stood in our legs like a cat and, then, while xing my gaze onher, I began to meow loudly like a kitten. Completely surprised, she remained

silent or a moment and then exclaimed, Youre crazier than I am! o whichI responded, Yes, but unlike you, they pay me to be crazy. She sat in silenceor a second or two, then, suddenly she looked at me with an impish grin andbegan to laugh heartily. She then calmly said, With you, I can talk.

Tis story illustrates the range o conversational resources available to thetherapist when he or she lets openness, dialogue, and acknowledgement othe other serve as a guide or his or her practice. It demonstrates how evenunusual modes o communication can be used to develop the relationship

between therapist and client. It also promotes a relational stance that seeksto engage the client in a shared language that transcends rigid prescriptionsabout how to proceed in therapy. Te therapist maintains a reexive awarenesso a relational space that includes him or hersel and the client, particularly, inthose moments when something different or new occurs in the conversation.Tose openings, which can be missed i awareness and sensitivity are missing,allow the therapist to invent and engage in innovative orms o relationship andexplore relational spaces that make collaboration, dialogue, and trans ormationin psychotherapy possible.

Co-creation of Competences and AbilitiesExploring these alternative spaces o relationship leads us to a second groupo practices that are undamental to a relational constructionist approachto psychotherapy: the co-creation and acknowledging o competencies andabilities. Tese practices are ounded on the assumption that clients haveabilities, strengths, and resources that i recognized and acknowledged mayhelp generate new constructive ways o solving problems, nding meaning,and re-imagining their lives (Bertolino & OHanlon, 2002).

Te idea that our clients are competent and capable human beings redirects thepsychotherapeutic conversation through paths not envisioned in a decit baseddiscourse. It moves us into experiential spaces where the person can acknowledgetalents and capacities that are ignored in the problematic identity that has beenshaped through his or her official story. It generates a conversation that includesnot only what is going wrong but also what is going well, and explores not onlywhat is limiting and generates suffering, but also what strengthens and generatesmeaning. Tis perspective acknowledges that, although the person may haveproblems and that his or her action can have undesirable consequences, he orshe is not the problem (White & Epson, 1990).


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Tere are multiple practices or attending and co-constructing competencies inpsychotherapy. For example, narrative and solution ocused and competency

based therapists suggest asking a client directly or experiences in their livesthat illustrates strengths and abilities or where theyve demonstrated theircapacity to ace obstacles, solve problems, and reach their goals (Bertolino &OHanlon, 2002; Walter & Peller, 1992; White, 2007). Bertolino and OHanlon(2002) also suggest re raming decit based descriptions to normalize whathas been designated as pathological or aulty. For example, hyperactivity canbe re-signied as being lled with energy, and having oppositional traits canbe re-conceptualized as dissidence or the conviction and willingness to de endones interests when subjected to pressures by those in positions o authority.

Discovering competencies, however, is not dependent on a particulartechnique or a orm o questioning. A therapist can assume a mode o listeningand participating in a conversation where he or she is constantly looking oropportunities to rame li e experiences and client traits as examples o strengthsand abilities. For example, as he or she listens, he or she can consider, How canthis expression, this relationship or orm o li e re erred to by the client, can beseen as a strength? How can it be used as a resource in psychotherapy?

Wild RoseTe ollowing narrative by one o my clinical students (Solis-Baez, 2009),provides an example o how attending to, discovering and co-creatingcompetencies in a therapeutic relationship can help to trans orm a clientsidentity and modes o relating and acting in the world.

Rose was a 50 year old woman who was re erred to psychologicalservices by a counselor rom a Government VocationalRehabilitation Program because she had difficulties verbalizingher problems or needs. She also had a stress ul li e situationbecause she was unemployed and had to care at home or aseverely disabled daughter. Te program had also requested thata psychological assessment be conducted in order to assess herintellectual capabilities so that she could gain entrance into a vocational program. Tis assessment was to be done by anothertherapist.

When I asked her questions about her li e during our rstconversation, she started to speak but would stop, begingesturing with her hands and head as i saying no and thenwould state I dont know how to say it, Im stuck. Tis cycle


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o communication was repeated several times during our initialmeeting. I sensed that she was tense and ear ul o whatever

it was that she thought I was there to do. I then began askingher questions about everyday activities hoping it would makeher eel more com ortable and allow me to gain her trust. Tisapproach opened up our conversational space and she began toarticulate her story.

Rose spoke about her difficulties in relating to others and aboutthe impact o having been labeled mentally retarded at an earlyage. She said that people told her she couldnt do things because

she was stupid and that she was reticent to talk to others orear o being ridiculed, so she elt very alone. Te thought oundergoing a psychological assessment increased that earbecause she anticipated that the results o the tests would deemher incapable o working in any job.

When we engaged in non-clinical talk, I discovered that shehad a particular ondness and talent or gardening. It was anactivity that she carried out every day especially, when she waseeling stressed or alone. Upon hearing this, I decided to speakabout my lack o talent or tending to plants and told her thatall o my houseplants had died because I could never tell thecorrect amount o water to use, or when they needed watering,and whether a particular plant should be indoors or outdoors,among other things. She then began explaining all o the differentways that plants told us what they needed. Changes in colorsignaled a need or more or less water; texture and compositiono leaves could tell you whether a plant needed to be indoors oroutdoors. When I asked her how she knew all o these things,she mentioned that these were things she learned only throughthe experience o having plants and caring or them in her home.As she continued to share with me her knowledge o plants, Inoticed that she was very com ortable and articulate. Tere wasno hesitation or verbal difficulties when plants and gardeningwere the subject. We had ound, through the course o theconversation, a language that she was very uent in!

When I shared this experience with my supervisor, he suggestedthat I explore other identities besides being the therapist. He


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asked me to let her be my teacher, so that I could learn aboutplants and their hidden language. He also reminded me that

her relationships with plants could operate as a living metaphoror her relationship with hersel and her own li e and could beused as a conversational resource or trans ormation.

As I began to relate to her as my new mentor, I discovered thatthrough the use o plants and gardening metaphors she was ableto express her emotions about different situations or the problemsthat she was experiencing in her everyday li e. For example, whenspeaking about lacking a sense o order she compared hersel to

a bunch o weeds growing wildly in a yard. When re erring toher daughter she would say she is like an orchid, very beauti ulbut very ragile. When describing how she elt people viewedher, she said she thought they saw a cheap carnation but thatshe elt like a wild rose because she was beauti ul once yougot past all o the thorns. She also compared the ways she eltwhen she spoke to plants to how she approached speaking withpeople, something, she said, made her very uncom ortable. Byhighlighting the different relationships she established with eachparticular plant and what worked with them, we were able toexplore and generate new ways through which she could putthose abilities to use when speaking and relating to others.

alking about plants, also allowed us to explore the apprehensionshe elt towards the psychological assessment that she neededto undergo in order to quali y or the Vocational RehabilitationProgram. Her concern, she stated, was related to the rejectionshe had elt in the past by others who deemed her retarded. Ourrelationship however, had given her an experience o relating asan expert with a pro essional as a student and thus, she hadgained a sense o competency, a sense that she described as thecondence that I can do things.

Once she could affirm hersel , we began to engage inconversations about times and domains in her li e where shehad been success ul (graduating rom high school and as anexemplary mother who took care o a severely disabled daughter,or example). Tis shif in ocus allowed her to recognize thatshe, like other human beings, had different strengths and


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weaknesses. Tis understanding undermined the narrative thathad placed her as being less, stupid or not as knowledgeable

as others. Tis, in turn, generated unanticipated possibilities oruture development. Be ore ending therapy, we co-created a planthat built on her strengths and that she could use to participatein new activities and social situations, as well as to prepare or auture job in gardening.

I later heard rom her rehabilitation counselor that she hadenrolled in and success ully completed a program where she wascertied to do gardening work. Te counselor was surprised to

nd out that the woman that had been plagued with so manydifficulties now seemed changed and trans ormed. In herconversations with him, this new woman he said, constantlyreminded me that she had a talent and passion or somethingthat not everyone could do (Solis-Baez, 2009).

Tis story illustrates a way o doing therapy that invites a person to reconsiderhis or her li e rom a perspective that promotes sel -valuing change. Teacquisition o this new vantage point enables the client to re-signi y events,restore orgotten narratives, and co-construct stories that stress vitality andmeaning. In this way, a client can participate in the creation o narratives thatassert his or her strengths and the capacity to rethink and re-evaluate his orher past and uture.

Reaffirming what is best in a person does not imply a new, repackaged version opositive thinking. Tis practice does not privilege a particular way o thinkingor being. Neither does it deny that there is suffering and hurt in li e. It re uses,however, to privilege perspectives that have turned naming and explainingwhat is dys unctional as one o the unquestioned needs in psychotherapy.Instead, it proposes an alternate approach to therapy that acknowledges thehuman potential to reinvent onesel , to overcome suffering, and to act inaccordance with ones most noble aspirations.

Te Crisis of FaithClients troubled stories are ofen saturated with suppositions and experiencesthat operate as truths and natural realities. In order to question these, there isa third group o relational practices whose goal is to provoke a crisis o aithin the clients belie s and ways o relating which help to maintain problematicnarratives and identities. Tey seek to demonstrate and experience the


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constructed nature o concepts we take as a given (Botella, 2006, p. 30), anddestabilize and break the perceptual curse through which an identity, a way

o relating, or a problematic story are assumed to be the only possible reality.Tey also maximize opportunities or breaking down the oundations o anyassumption, belie , or idea that taken as an absolute truth has served to limitthe ability o a client to re-signi y his or her story and/or generate a morehope ul and enabling narrative.

In attempting to provoke a crisis o aith, a therapist takes advantage oinconsistencies that may appear within a particular discourse or alternateidentities and narratives that are not part o the official story. Different

conversational and relational resources, such as reective dialogue, hyperbole,paradox, challenge, humor, analogy, metaphor, and story, may be used togenerate a crisis o aith. Different dramatic modalities such as role-playingreal and imaginary gures can also be employed.

Using these resources requires that a therapist be able and willing to alter theexpression o his or her identity in ways that allow him or her to adapt to thechanging conditions o his or her relationship with the client. Tis implies, orexample, that on occasions, a therapist may assume an identity that expressesempathy and compassion, while at other times he or she can become anincisive and persistent inquirer. Te therapist can also become a storyteller,per orm multiple dramatic roles, and make extensive use o metaphor andhumor (Gilligan, 1997).

By not maintaining a xed identity, the therapist turns into a orm o audiencethat can respond in unusual and unexpected ways to the clients storiesand ways o relating. Tis makes him or her unpredictable and difficult toplace. Te clients narrative and dramatic expression may be lef without theaudience and the orm o relationship needed to maintain it. Tis may provokealterations in the clients identity and mode o relating in order to respond tothe new relational context where the story is being told.

A crisis o aith can occur when client and therapist collaborate together inaccessing realities and perspectives that undermine the belie s and ideas thatsustain the clients official story. Tis may require the recall and explorationo experiences that have been marginalized and discounted as a strategy toundermine the truth that hold the clients imagination in captivity.


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Te Community OrganizerSeveral years ago, a client who worked as the administrator o a community

based enterprise, asked me to meet her in her office in order to deal with apersonal crisis. When she called, she was in a heightened state o anxiety. Shehad been weeping locked in her office or more than two hours. Tat afernoon,the Board o Directors o her organization, was holding an emergency meetingthat required her presence. She was concerned, that because o her emotionalcondition she would be unable to attend. When she asked me or my help, shetold me, I dont think I have a way out. Given how I eel, I cant possibly be atthat meeting in two hours.

When I arrived at her office, I ound her inconsolable, repeating over andover again: I have no uture; my li e is over. When I asked her what waswrong, she told me that during the last ew weeks, a regional newspaper hadbeen publishing a series o articles that questioned her organizations businesspractices. In an article that appeared in that days newspaper, she had beenaccused o corruption and o using the organizations deposits or personalgain. She maintained that all the in ormation was alse and that the reporterhad never interviewed her to corroborate the charges that appeared in thearticle.

I listened to her attentively, while she explained her eelings o humiliation andshame. She was worried that her grandmother and daughter, whom she hadraised as a single mother, would read the newspaper and think that she hadbeen engaged in criminal acts. She was also concerned about her pro essionalreputation and her standing in her community. Full o sadness, she loweredher head and broke into tears. Ten she added: Whats worse is that the onlything I hear in my head is the reporters damn voice, accusing me again andagain o being a thie I just eel theres no way out.

As I listened to her or the next ew minutes, I remembered several o ourprevious conversations and her history as a community leader and a responsiblesingle mother. I waited or a moment o silence. Ten I asked her in a pausedand dramatic tone, I understand you can hear his voice, but I wonder i youcan listen to the other voices. She looked at me with a perplexed gaze andasked me, What voices are you re erring to?

Your grandmother and your daughters voices. I paused or a ew secondsbe ore going on. I they were here, in this office and saw you crying, Wouldthey speak to you as he does? Would they say the same things? I paused


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again, giving her a moment to consider my question. I then went on, speakingcare ully and slowly. I dont know i you can listen to their voices I dont

know i you can notice and eel the way they would approach you.

She stopped crying and answered, Tey would give me support. Tey wouldsay they love me and my daughter would hug me. Ten, I asked, Now, that youcan see their loving eyes, and listen to their words and eel your daughters armsaround you How does that make you eel? A lot better, she answered.

By now, her breathing had changed and had become deeper and uller. Icontinued, attempting to engage her through my words. I know you can already

listen to their voices, but the one thats here is in crisis. Tere are other voicesthat are needed. Curious, yet puzzled she asked, Who are you re erring to?. I answered as i it was obvious, Well, you know the others...the woman thatovercame all kinds o difficulties in her li e through her own efforts, the onewho raised a daughter and took care o her grandmother. Is she here? Can youhear her?. I paused or a ew seconds, long enough to notice that her eyes wereno longer reddened by tears. Ten there is the community leader, the onewho helped the elderly, students, and the poor Is she here? Can you listen toher?. Again I paused. And then there are the thank ul voices, the others thathave blessed you in their prayers. Are those voices here with you? Can youlisten to them? Can you eel them as they speak to you and remind you .?.

Te change was already noticeable. Fragility gave way to determination andcondence. Ten she said, I eel as i I have all o them here with me, talkingto me, giving me support. I had orgotten I have a lot o people on my side.

Tis was the beginning o a ruit ul conversation that helped her to reconsiderthe many truths that she had taken or granted. She discovered, or example,that the reporters voice was one among many voices that she could listento. When she began our conversation, there only existed two voices in herconversational space, her accusers and the one who belonged to a womanisolated and weakened by his accusations. Trough our dialogue, other voices,identities, and points o view emerged questioning the realities she had takenor granted and helped reaffirm her worth and gave her back her sense opurpose.

Tis example dramatizes the way through which therapist and client canparticipate in deconstructing and co constructing the realities in psychotherapy.


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Trough listening and communication, the therapist acknowledges theimportance o what the client eels. He uses different ways o speaking to

generate a dramatic intensity and capture the listeners attention. Trough useo questions and suggestion, other social realities emerge. Te client enters aworld where amilies, riends, and colleagues join together as a supportive andaffirming imaginary community that enables her to question, reconsider andre-imagine her situation.

Each o these relational moves acquires meaning in the nexus o the relationshipwith the client. As a therapist, one is led by what one listens to and the waythe client responds and attributes meaning to what one does. In this case, the

client accepted an invitation and collaborated with it. Trough words, silences,and gestures a conversational dance was created. Te co-created language owords, silences, gestures and body movements made it possible or the clientto question what had once seemed like xed and unalterable realities. Troughthat language, an alternate identity that generated new possibilities or actionwas orged. It allowed this client to access and rely on a community oimaginary presences and relationships to re-signi y and discover her strengthin the ace o what once seemed to be a serious and insurmountable threat toher personal integrity.

Final ObservationsI have presented a view o psychotherapy ounded on the constitutive powero language and human relationships, and which conceives psychotherapy as aconversation, in which therapist and client participate in the co-constructionand re-construction o pasts, presents, and utures. I have also suggested thatthese realities are ever changing and uncertain. Tat is to say, we never knowexactly what awaits us in the conversations we hold in psychotherapy andwhat meanings will be generated through them. When acing uncertainty, Ihave suggested the importance o being sensible in the interactive moment,because as Gergen (2005) states, We never know when or how a door willopen (i it opens) into another better way o living (according to a certainpoint o view) (p. 174).

Acknowledging the constitutive power o language has important implicationsor the therapist. It makes him or her question orms o language and relatingthat generate realities which incapacitate and restrict the ability or reinvention.It also leads the therapist to undertake practices that open up new possibilitieso relationships and re-imagination. I explored three o these in this text and,through examples, illustrated ways in which they may be used. Tese, however,


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are only ew o the many o dialogic options that therapists may access whenhe or she relates rom a stance that acknowledges the participatory and co-

constructed nature o the realities that client and therapist live, in and outsideo therapy.

In concluding, I wish to borrow Gergens (2005) proposal to re-conceptualizepsychotherapy. He suggests that instead o using a language based on mechanicsand cybernetics to describe psychotherapy, we are better served by the useo a more imaginative and literary approach. He challenges us to re-imaginepsychotherapy as a literary orm that can be ounded on three characteristicso poetic language: the capacity to scrutinize what is common and ordinary,

to make the imaginative credible, and to generate an aesthetic sense in therelationship between client and therapist.

Gergens proposal synthesizes the essence o what I have shared. It invites usto re-imagine psychotherapy and our work as therapists. It suggests that weree ourselves rom orthodox clinical chains that, with their deciency basedlanguage, prescriptions, and pretensions o control and prediction, trans ormspsychotherapy into a technical activity that lacks imagination and soul. Itproposes a vision that empowers the client and makes him or her, a participant inthe co-generation o realities that are re-invented through the psychotherapeuticdialogue. It also invites us to use our imagination to participate in a poly-vocaland pluralist world, where our relation to the unknown and the un oreseengenerates mystery and enables the possibilities o creation. Listening to,immersing ourselves in experiential worlds, questioning and destabilizing,generating alternate utures, and establishing a certain aesthetic in our wayso conversation and interaction, all are part o the rich tapestry and dance wecall psychotherapy. Terapist and client speak together to reconsider the oldand reinvent the new, to re-imagine and generate as Gergen (2005) says, adiscourse o dreams, a discourse that believes in the image o what is to comeo a hope ul, stimulating and captivating uture (p. 81).

Please address correspondence about this article to: Pro essor Edgardo Morales-Arandes at [email protected].

References

Anderson, H. (1997). Conversacin, Lenguaje y Posibilidades, Buenos Aires,Argentina: Amorrortu.

Anderson, H. (2007). Dialogue: People Creating Meaning with Each Other and


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Therapeutic Heresies: A relational constructionist approach to psychotherapy

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