| DECONSTRUCTION, POST-(?)-MODERNISM AND THE FUTURE OF PSYCHOTHERAPY
Magdalen Medical Practice, Lawson Road,
Norwich NR3 4LF
Ian Parker (ed.), Deconstructing Psychotherapy, Sage, London, 1999, 194pp, index, ISBN (p/b) 0 7619 5713 8, price (pounds sterling)13.99 (h/b - 0 7619 5712 X)
Ian Parker has the enviable knack of producing leading-edge books which are significantly ahead of the therapy field in terms of their theoretical and practical prescience. In this regard perhaps it is a positive advantage not to be thoroughly and professionally immersed in the therapy world! (Parker's academic label is that of a critical (social) psychologist, being Professor of Psychology and Director of the Discourse Unit at the UK's Bolton Institute). Just as the multiply authored text Deconstructing Psychopathology (Parker et al. 1995) brilliantly challenged the incoherent ideological trappings and abusive professional practices surrounding the notions of '(ab)normality' and 'psychopathology' in the field of mental health and emotional distress, so this latest anthology offers us a truly cutting-edge introduction to some of the most exciting developments in the therapy field. As such, the book makes a thoroughly refreshing change from the unremitting diet of mainstream, profession-centred therapy literature that has poured forth from the publishers' presses in recent years (and which, of course, itself constitutes a central aspect of the political economy of the burgeoning therapy 'profession', and its accompanying material interests).
It is central to the book's raison d'etre that 'deconstructive therapy' (if such a phenomenon can even be meaningfully proposed, which at least some of the book's contributors would dispute) is emphatically not just one more school or type of therapy, to be added to the 450-odd other versions identified at the last count. Rather, the book offers a fundamentally different 'approach' to therapy - one that, not least, challenges the very notion of an 'approach' or 'position' (or 'an approach which is not one', one might say).
The term 'postmodernism' (or the 'P word', as Roger Lowe calls it! - p. 73) is a rather malleable, loosley defined term which often triggers strong emotional reactions, and which can serve to obscure far more than it illuminates; and for this reason some have suggested that we replace the term with less emotive ones, like (for example) 'a generalized climate of problematization' (Lowe, ibid.). Rorty has recently gone as far as concluding that 'The term [postmodernism] has been so overused that it is causing more trouble than it is worth' (1991: 1).
Certainly, the 'postmodern turn' in therapy and psychology (Messer et al. 1988; Faulconer and Williams 1990; Kvale 1992; House 1999b) has been prompted by a profound epistemological and political disillusionment with their perceived modernity, with their accompanying beliefs in
a referential-representational view of language; individual autonomy and rationality on the part of therapists or clients (knowers and the known); historical, scientific and disciplinary progress; the desirability of grand and unifying theories and singular forms of knowing; objective and disinterested knowledge and professional expertise; and autonomous spheres of society.(Lowe, p. 75)
The book's title constitutes a highly pertinent double entendre, in that it conveys both the notion of 'a therapy which is deconstructive', while also conveying a deconstructive critique of the very notion or project of therapy as conventionally understood. As will become clear in what follows, the book does indeed address both of these important senses of the term 'deconstructing psychotherapy'. In addition, Parker further disaggregates the former into 'deconstruction in and as psychotherapy' (p. 11) - see below.
In what follows I set out a brief overview of the book, followed by a more detailed discussion of it's central themes, with particular attention given to the central post-structuralist figures, Michel Foucault and Jacques Derrida, whose work is recurrently influential throughout the book.
Deconstructing Psychotherapy begins with a position chapter by editor Ian Parker, in which he critically reviews the field in general, as well as offering contextualised summaries of the book's constituent chapters. Part I, 'Sources and Contexts for the Deconstructive Turn' (or what Parker calls 'Deconstruction in psychotherapy' - p. 11) is for this reviewer the core of the text, with five chapters that offer theoretical perspectives on deconstruction and postmodernism, and with some reference to institutional settings. More specifically, there are chapters on narrative therapy (John Kaye), Derrida (Glenn Larner), Foucault (Vincent Fish), postmodernism (Roger Lowe) and feminism (Nollaig O'Reilly Byrne and Imelda Colgan McCarthy). The chapters by Kaye ('Toward a non-regulative praxis', Larner ('Derrida and the deconstruction of power as context and topic in therapy') and Lowe ('Between the "no longer" and the "not yet": Postmodernism as a context for critical therapeutic work') were found to be especially outstanding contributions.
Part II, 'Deconstruction in Practice' (or - Parker - 'Deconstruction as psychotherapy') contains four chapters which offer practice-oriented commentaries on how deconstructive approaches can transform power relations and discursive practices in relation to: a feminist-informed narrative therapy (Vanessa Swan), therapy with men (Ian Law), working with issues of (religious) faith (Wendy Drewery, with Wally McKenzie), and the stunting of identity stemming from an objectifying psychiatric framework (Stephen Madigan). Finally, Part III, 'Deconstructing Psychotherapeutic Discourse' (or 'Deconstruction of psychotheapy'), concludes with two chapters that, respectively, discuss how deconstruction can problematise conventional problem catagories (John Morss and Maria Nichterlein) and how it can lead to a fundamental questioning of the very foundations of psychotherapy (Eero Riikonen and Sara Vataja). Of the six chapters in Parts II and III, those by Madigan ('Inscription, description and deciphering chronic identities', and Riikonen and Vataja ('Can [and should] we know how, where and when psychotherapy takes place?'), made a particularly strong impression on this reviewer.
One interesting and notable feature of the book is its truly international authorship: for apart from Parker, no other contributor is from Britain, with authors from Australia and New Zealand, the USA and Canada, Ireland and Finland. Australasia is particularly strongly represented with no less than six contributors (out of sixteen), which is no doubt fitting given the important deconstructive-therapy movement which has thrived there for over a decade, centred on the pioneering work of Michael White and David Epston (White and Epston 1990; White 1991). The dearth of British contributors highlights the importance of the book's publication for British practitioners increasingly dissatisfied with the conventional modernist therapy paradigm, and who are looking for new radical directions for their theory and practice.
The central 'protagonists' in this text are the two great and controversial post-structuralist theorists Michel Foucault and Jacques Derrida. I will devote two major sections to their work and the way it is weaved into the text, before moving on to a more general discussion.
FOUCAULT AND POWER
Power is surely an issue which has received a woeful lack of attention of in the therapy world, and in this book Michel Foucault's views on power, including what he called 'power/knowledge' (p. 55), are a central and recurring theme, with readers thereby being offered a highly illuminating viewpoint on this much neglected issue. For Foucault, accompanying the Enlightenment, 'reductive theoretical constructions of various aspects of human existence cohered with modern forms of social regulation; [and]... these regimes of power/knowledge continue to structure the field of human interactions while constituting the terms of individual experience' (Fish, p. 54). For Foucault, power/knowledge refers to 'the constant, ubiquitous effects of [the] conjunction of systematized knowledge and material arrangements upon both subjectivity and human interactions' (ibid., p. 55):
Foucault described both the mutuality of knowledge and power and the extent to which all ways of knowing are exercises of power. This power is not reducible to interpersonal domination, but is constitutive of social life and culture generally.... Power is normalized, rendered into discipline, practised routinely by subjects upon themselves as they re- enact the premises of their culture.... We must... see [power] as a dynamic or network of non-centralized forces.... [T]hese forces... assume particular historical forms, within which certain groups and ideologies do have dominance... - sustained through multiple processes of different origin and location regulating the most intimate elements of the construction of space, time, and desire. (Madigan, pp. 156-7)
Moreover, there is no need whatsoever to invoke conspiracy or Milibandian theories of (state) power:
power does not derive from a central authority, is non-conspiratorial, and indeed non-orchestrated.... Where power works from 'below', prevailing forms of selfhood and subjectivity are maintained through individual self-surveillance and self-correction of established norms. (ibid.)
Or as Foucault himself put it, the individual will be 'his own overseer, each individual thus exercising this surveillance over, and against, himself' (quoted on p. 157).
For Foucault, then, power is 'exercised rather than possessed' (quoted on p. 119), and power 'is not a possession of individuals or the central apparatuses of the State' (Byrne and McCarthy, p. 94). For Foucault there exists a dialectical relationship in which 'the individual constitutes power relations and is in turn constituted by them' (ibid.).
For Law, 'Power is the collection of discursive practices performed that serves to maintain the strategic position of a given discourse and those persons who have access to its privileges' (p. 119). In turn, discursive practices are defined as 'ways of talking, thinking, feeling and acting that, when enacted, serve to reinforce, reproduce or support a given discourse and at the same time deny, disqualify or silence that which does not fit with that discourse' (ibid.).
If one really embraces these radical views on power, then one cannot but conclude, with Fish (p. 55), that
it is critical for psychotherapists to keep in mind the immediate,
inescapable connection between, on the one hand, clients' and therapists'
subjectivity and behaviour, and, on the other, historical, ongoing
institutional and cultural processes.
Moreover and of equal import, it also becomes crucial to 'explore psychotherpay as an institution', and 'to further our understanding of the political, historical forces that have shaped, and continue to shape,... its discourses and practices' (ibid.).
It is worth noting that Foucault did not argue for what he would have seen as an untenable denial of expertise and knowledge, for he 'contradicts those... who suggest that therapists can and ought to mitigate the power inherent in their "expert" knowledge' (Fish, p. 67). For Foucault,
power relations are not something that is [sic] bad in itself... I do not think that a society can exist without power relations... The problem, then,... is to acquire the rules of law, the management techniques, and also the morality... that will allow us to play these games of power with as little domination as possible. (quoted on p. 67)
This seems to this reviewer to be both an overly optimistic and overly pessimistic view of power, at the same time: over-optimistic in the (naive?) faith it places in the capacity for 'rules of law' and 'management techniques' healthily to address issues of power (cf. House 1999a); and over-pessimistic in its view that power relations are necessarily an inevitable accompaniment of human relationship. I would maintain that Foucault's view is one that is squarely rooted in the discourse of modernity, from which position he could, of course, reach no other conclusion. A view of these same issues from a 'transmodern', new paradigm 'position' might well yield very different perceptions. For some of us at least, then, it seems that Foucault may not be radical enough!.... Elsewhere, for example, Luepnitz has pointed out that, contrary to the practice in much narrative therapy, 'Foucault would never have concurred with a therapist being defined as 'non-expert'; and that nowhere does he propose 'liberation' from technologies (though some are certainly more oppressive than others) (1992: 281, 282).
Both Swan and Law (Chapters 7 and 8 respectively) draw heavily upon Foucault's perspectives on power, gender and discursive practices to outline the relevance of his work to a feminist-informed narrative therapy and a discursive approach to working with men, respectively. Law uses the notion of 'discursive practice' in a case study (pp. 120-7) which the therapist 'explicate(s), situate(s) and trace(s) the history of the various discourses that are mediating the sense that [clients] are making of their experience' (ibid, p. 120); for in such an approach, 'Naming... may open space for the consideration of alternative practices or counter practices' (ibid.).
DERRIDA AND DECONSTRUCTION
Parker offers us a useful 'first handle' for grappling with what deconstruction might consist in: 'Deconstruction is... a processual activity tht defies definition.... [it] is not a thing, and cannot be summed up in a neat definition or be put to work as a discrete technique' (p. 11). What Parker (p. 2) terms 'deconstructive unravelling' is a kind of 'method which is not one', a looking for 'the ways in which our understanding and room for movement is limited by the "lines of force" operating in discourse' - or the role of power in defining problems, with the location of our own understanding of problems lying within discourse (ibid.). Parker defines deconstruction as 'a process of critical reading and unravelling of terms, loaded terms and tensions between terms that construct how we read our place in culture and in our families and in our relationships, and how we think about who we are and what it might be possible for us to be' (pp. 6-7).
While modern(ist) 'scientific' psychology seeks 'essential', universal laws and largely ignores difference, Derridean deconstruction maintains that 'the recognition of difference forces us to abandon any essentialism or foundationalism... since language constitutes meanings not in terms of the essence of a thing but in its difference from other things' (Madigan, p. 153). Deconstruction highlights the paradoxes, contradictions and double binds that inhere in discourses of power, with the intent of limiting the repression of the other's difference (Larner, p. 39).
Indeed, paradox and contradiction are central to the phenomenon of deconstruction - 'a postmodern quandary' in which 'the dilemma of power is how to take a position... when such positioning itself involves a "violence that founds or positions"' (ibid.: 40, quoting Derrida, original emphasis). For Derrida, deconstruction is actually defined in terms of the paradoxes of power and justice (ibid.: p. 44); the paradox of power cannot be grasped via reason and language, and must be lived with (ibid.); and deconstruction 'can never begin and is always beginning, as an impossible enquiry into the limits of power and knowledge' (p. 43).
Derrida himself has in fact never described his writings as 'deconstruction' (p. 42): for him, deconstruction constitutes 'a proliferation of genres, styles, voices... plurality that no concept of deconstruction could hope to totalise' (Gasche, quoted in ibid.). For Derrida, deconstruction should never be reduced to a 'fashion, a school of thought, an academic current, a theory or a method... There is no such thing as a deconstructive enterprise - the idea of a project is incompatible with deconstruction' (Derrida, quoted on p. 43, original emphasis). Moreover, deconstruction embraces 'both-and' rather than 'either/or' logic, and 'thinks opposites -for example, meaning and non-meaning, power and non-power - together' (p. 45, original emphasis).
It is impossible, then, to not take a position, and it is an illusion to believe that we can step outside power, foundations or the real: 'The deconstructionist has one foot inside and the other outside the deconstructed system' (ibid.). As the adopting of a postmodern position simply repeats a modernist violence, Larner advocates a 'para-modernism' which is at the same time both modern and postmodern - referring to 'a knowledge that is "not-knowing" as a stable instability, a groundless ground, an uncertain certainty and a position of power that is non-powerful' (ibid.). For 'All positions are grounded in "a kind of violent exclusion that must efface its other and eliminate difference to preserve its purity"' (Nealon, quoted by Larner, p. 50).
With specific reference to psychotherapy, a deconstructing psychotherapy expresses a tenacious double bind around power and knowledge (explored more fully below): 'To deconstruct psychotherapy in the spirit of Derrida, is to purge the cultural idols of power, technology and mastery from therapy, while acknowledging that we can never quite leave them behind' (Larner, p. 40). There is clearly a strong link between Derrida's and Foucault's work around power: thus, for example, the way in which Derrida does not renounce or argue for the dissolution of power, and advocates its humane and just exercise, is not dissimilar to Foucault's position (see above discussion). The influence of these two important thinkers recurs throughout the book - as will be clear in the remainder of this article.
[S]taying within the modernist repertoire may render psychotherapy obsolete in the sense that its emphasis on cultural adjustment tends to preclude its potential to assist in the construction of new relational possibilities.(Lowe, p. 81)
In his position chapter, Parker offers a wide-ranging, contextualising perspective on deconstruction in/as/of psychotherapy. He begins by pointing how conventional approaches to therapy can all too easily be re-abusive rather than emancipatory: 'Forms of psychotherapy... whether these are behaviourist, cognitive or psychoanalytic..., take for granted descriptions of pathology which often oppress people as they pretend to help them' (p. 2; cf. Parker et al. 1995). In the practice of 'deconstructing psychotherapy', in contrast, people's difficulities are 'understood as narrative constructions rather than as properties of pathological personalities, and as embedded in discursive practices rather than flowing from developmental deficits' (p. 2).
Parker usefully outlines a number of key features of what he terms 'a deconstructing psychotherapy' (the '...ing' being important, as it conveys the idea of an ongoing process):
¤ it is 'always in process, rather than something fixed, a movement of reflexive critique rather than a stable set of techniques' (ibid.);
¤ it is 'profoundly respectful' (p. 3);
¤ it pays close attention to contradiction (ibid.);
¤ it is 'intensely critical...: [it] does not presuppose a self under the surface.... To be "critical"... means understanding how we come to stand where we are' (pp. 3-4).
In the world of deconstructing therapeutic practice 'We are always already embedded in a particular set of perspectives, operating from within certain positions when we try to understand ourselves and others' (p. 4); and 'the task of the deconstructing therapist... is to... comprehend the role of patterns of power in setting out positions for people which serve to reinforce the idea that they can do nothing bout it themselves' (p.3).
Parker goes on the examine two existing examples where deconstruction and therapy have already had a fruitful meeting - namely, in family therapy, and in critical psychology. In the former case, he points out a la Foucault, for example, the parallel between the double binds and 'knots' found within families, and 'the paralysing contradictory messages that traverse a culture and position individuals within various discourses and discursive practices' (p. 7; cf. later discussion). The more radical deconstructive family therapy practices focus directly upon how discourses and power actually constitute 'problems' 'that position the client as helpless and as believing that the problem lies inside them' (p. 8). The adoption of a reflexive stance within family therapy leads practitioners to reflect upon the cultural assumptions underpinning the project of psychotherapy and to engage in a process of ongoing deconstruction of the communities of which they are a part (p. 8; cf. House 1999d).
Critical psychology (e.g. Fox and Prilleltensky 1997) entails a strong critique of the conventional professional institutions of psychiatry and psychology, and their accompanying clinical practices which consist of ideologies which 'locate thinking and feeling inside individuals' (p. 9). Thus, for example, the narratives of institutional Psychology constitute through reification certain 'psychological states', and
Psychologists are then able to recognize these states as being the things they can predict and control, and this then constitutes individuals as subjects of the wider apparatus of surveillance and regulation in Western culture that psychology feeds upon and operates within.(ibid.)
Parker concludes by warning us not to expect a book whose contributors speak with one single, non-contradictory voice - which, in an appropriately pluralistic universe in which deconstruction in psychotherapy takes different forms in different parts of the world (p. 14), is just as it should be.
The chapters in Part I collectively offer a very powerful, authoritative and convincing overview of the postmodern, deconstructive turn in therapy. Larner's chapter, referred to in the earlier section on Derrida, provides an outstanding introduction to Derrida's work and its relevance to deconstructing/ive therapy. The deconstructing therapist is immediately faced with what Larner terms 'the postmodern quandary': 'how to think, act and know in the absense of transcendent grounds, reason, truth and foundations; how to critique an institution when no outside grounds or positions can be taken, and avoid one's position becoming institutionalized...' (p. 40). For the deconstructing therapist, the inherent paradox of deconstruction, referred to earlier, means that the deconstructing of power witjin therapy 'requires the action of a powerful therapist to "not know" and it requires a powerful knowing at another level, a "not knowing" knowing' (ibid.).
Thus, a deconstructing therapy is both powerful and non-powerful (p. 41); and in ongoingly deconstructing its own power and authority as an institution, it will hopefully 'remain innovative and open to its own possibilities, rather than being subject to closure under the regime and institution of theory' (ibid.), and 'prevent its institutionalization as yet another totalizing discourse of truth, a deconstructive orthodoxy which is potentially violent in closing off difference and otherness' (p. 43). The approach to theory is central here, for the other is related to as a 'strange' other, rather than in terms of a theory of the other (p. 48):
The other is not merely the 'socially constructed' other, but other, with a different existence... [T]o listen to, rather than assimilate the other as one's construction (in imagination or in theory), requires a hierarchy that is for or favours the other..., in which both therapist and client are powerful and non-powerful... The position the deconstructing therapist takes is both inside and outside power simultaneously.(pp. 48, 49, original emphases)
Thus, in taking up the question of the ethical aspect in therapy, Larner stresses that the therapeutic relationship is 'intentionally asymmetrical or hierarchical' (p. 47); and although the therapist is unavoidably invested with the power of technology and expertise, the ethical stance of the therapist towards the other 'balances this hierarchy, tempering the violence' (ibid.). Such a stance necessarily involves the honest, and sometime painful, interrogation of the therapist's own interests in the therapeutic encounter - including, for example, 'the need for therapists to be successful, to establish a career and reputation in the market place, a professional niche; personal needs for control and power; the demands of a particular approach or ideology...' (p. 49).
In sum, then, a deconstructing psychotherapy is not a particular method, school or theoretical doctrine that can be labelled (p. 49), and the task of deconstruction is 'to expose the violence inherent in the notion of "therapy"' (p. 48).
Roger Lowe interestingly and provocatively locates postmodern deconstruction in the in-between transitional space between the modernity that is no longer viable, having essentially lost all epistemological credibility, and the kind of 'post-postmodern' therapy which we have not yet created. I liked Lowe's characterisation of postmodernism as 'a metaphorical transitional boundary', evoking 'a self-consciously transitional moment' (p. 72, quoting Lather) - that is, postmodernism is in fact not an 'ism', a thing, but rather, a key transitional moment in the evolution of ideas and human consciousness, a moment denoting both an important disillusionment with the objectivist Enlightenment project of modernity, and a liminal space which presages a 'new' which is as yet undefined and unknown (and may, of course, remain intrinsically so, as 'knowing' and 'definition' themselves are increasingly problematised).
Lowe also highlights the critical question of how we can avoid a postmodern 'approach' simply becoming another modernist discourse under a different label:
how can we avoid reinventing the modernist wheel?... how can we ensure that postmodernist ways of talking do not end up doing the same work as modernist ones?... The... danger is that of professional institutionalization and re-assimilation to a modernist conversational repertoire based on objectivist knowledge and instrumentalism.
(pp. 77, 82)
Relatedly, he also makes the sobering point that postmodern critique is the easy part (p. 77); whereas the operationalising of a descriptive postmodern praxis is another matter altogether. This will be very familiar, of course, to those who embraced critical Marxian theory in the 1970s and 1980s, and found its devastating critique of capitalism to be far from matched by a viable and sustainable implications for political practice.
The modernist world-view is indeed still extraordinarily powerful (as Thomas Kuhn showed, paradigms that are on the verge of being transcended go to desperate lengths to re-assert themselves, even in their death throes); and it seems that for the foreseeable future, new paradigm thinking must needs assert itself in a kind of 'ongoing revolution', while we are still routinely faced with a control-freak modernity saturating our culture and institutions. Lowe also raises the question that has concerned many a critical realist (e.g. New 1996) - namely, how is it possible to reject the foundationalism of modernity without necessarily lapsing (as he would see it) into an anti-realist stance? Swan (p. 106) offers a potentially fruitful answer to this when she writes that 'We cannot stand outside of discourse, but we can be selective about which discourses fit better with our values and have less harmful effects on the wider community'. Unfortunately, there is no overt representation in the book of the radical new paradigm viewpoint which would even problematise '(critical) realism' as a valid and viable epistemological world-view (House 1999a).
Lowe also has some interesting things to say about the ideological 'regime of truth' which conventional therapy so commonly becomes:
many conventional therapy 'realities' such as the classification of disorders... [in] DSM-IV are no longer seen as actual states of being, but as historically situated ways of talking which have constitutive effects in the way clients and therapists are positioned in terms of identities, obligations and entitlement. (p. 76)
And such a discomforting perspective is even more 'disruptive' when applied to the professionalised way in which the field institutionally constitutes itself (cf. House and Totton 1997; House 1999b):
The modernist conversational repertoire tends to speak into existence a specialized sphere of activity which is the appropriate business of 'psychotherapy', and to demarcate this from non-therapeutic sphere.... [T]he profession of psychotherapy can be seen as an institution which gate-keeps the discursive repertoire of cultural standards and desired ways of being.... [H]istorical emergence within a particular modernist discourse... has contributed to a distinctive individual and internal focus in the profession's conversational repertoire, rather than a cultural and relational focus.(p. 76, 77)
In other words, postmodern deconstruction problematises not only the 'clinical' procedures of therapy, but also the professionalised institutional structure which it takes and the individualised, privatised self-focus which the 'Professionalised Therapy Form' (House 1999b) actively creates. And for Lowe, all therapists have 'an ethical obligation... to actively participate in the deconstruction of their own texts, rather than complying with an external mandate' (p. 81).
Finally, I was greatly drawn to Lowe's notion of 'discursive health warnings' (pp. 81-3), whereby 'Perhaps all therapy discourses should contain built-in discursive health warnings, through which their role in rhetorically shaping the objects of which they speak is revealed rather tha concealed' (p. 81). There is a major issue around informed consent (or, rather, the notable lack of it) within therapy; and it seems to me that there is a very considerable ethical imperative for therapists ongoingly to question the particular 'regimes of professional truth' with which they (self-interestedly?) expect their clients to comply (cf. House 1999b).
John Kaye starts out with the question as to whether therapy can be effective without at the same time becoming an instrument for social control and a reinforcer of dominant discourses (p. 19). His chapter on narrative therapy presents a formidable and thorough-going critique of conventional therapy, as well as a useful articulation of what he calls 'discursive therapy'. For Kaye, 'The word "psychotherapy" unavoidably carries overtones on acting instrumentally on another in order to remedy some psychological defect or deficiency' (p. 34). Thus, conventional psychotherapy is seen as a 'normalizing practice' (pp. 20-2), which assumes 'an underlying cause or basis of pathology; the location of this cause within individuals and their relationships; the diagnosability of the problem; and treatability via a specifically designed set of techniques' (pp. 20-1). Lurking within such a top-down, instrumentalist formulation are implicit assumptions about ab/normality (cf. Parker et al. 1995), the objectively establishable 'true root cause', and
the concept of the therapist as having privileged knowledge, a socially accredited expert who can both provide an authoritative true version of a problem and act according to a set of prescribed activities to correct it.(p. 21)
Moreover, conventional therapy typically 'instantiates the notion of people as rational autonomous individuals possessing a fixed identity, an essential self vested with agency and a consciousness which is the cause of their beliefs and actions' (p. 22).
Drewary and McKenzie (Chapter 9) offer an interesting and highly readable discussion of how a deconstructive narrative therapy approach might respectfully work with clients bringing strong religious convictions - their aim being to show 'how it is possible to both acknowledge external authority or power [e.g. God - RH] and invoke personal agency' (p. 135). In other words, the authors set themselves the delicate task of showing how a belief in God can be compatible with notions of personal volition and agency. For these practitioners, 'the overt respect of the therapist for this dominating discourse in his life is an integral part of this therapeutic encounter' (p. 143).
The authors interestingly refer to parallels between their approach to narrative deconstructive therapy and cognitive therapy (p. 144) - an impression that this reviewer also has from time to time. Consider, for example, the following a passage from Swan's chapter (p. 105), which is in some ways remarkably evocative of cognitive therapy:
[T]he process by which wider societal discourse and the normatiuve rules this constructs can be seen to operate and inform our sense of who we are in the world. By specifically looking in detail at how this happens, opportunities for change... can be highlighted and thereby made available.
It might make for a very useful 'compare and contrast' exercise for someone to articulate the extent and the limits of these parallels, lest narrative therapy be assimilated by a 'flavour of the moment' cognitive therapy which in reality surely differs in quite fundamental ways from the narrative approach, notwithstanding some superficial similarities.
I really liked Drewery and McKenzie's boldness in questioning quite fundamentally the highly problematic modernist assumption that therapists necessarily know what they're doing (cf. Spinelli 1995): 'we have to come to understand...every client to be, in some sense, a mystery' (p. 139). And suhc a view is echoed in the final chapter, where Riikonen and Vataja write of 'the sheer impossibility of non-ambiguous descriptions of any human interaction and the healing elements it contains.... there is no reason to think that we know what psychotherapy really is' (pp. 176, 177, original emphasis).
In what is another outstanding chapter, Stephen Madigan offers a thorough-going critique of the institutional discourses of psychiatry and psychology. The chapter positively teems with memorable quotations and incisive insights - for example, that as language constitutes meanings in terms of its differences from other things (following Derrida), then we are logically forced to abandon the foundationalist search for the essense of the real (p. 153); and that there is an important distinction between 'identity' and the self-contained individual of the western Enlightenment (pp. 153-4). I particularly liked Madigan's openly subversive challenge to what I have elsewhere called the 'Professionalised Therapy Form' (House 1999b), where he refers to 'the rules of organized therapy', which include 'the ritualized dialogic structire of the interview..., a session's tempral organization, client billing and other relational politics often left as unquestioned practices and performances of power' (pp. 154-5, emphasis added).
More generally, Madigan's chapter is an exemplary model of how to do effective case study reporting, with actual transcriptions weaved into a wide-ranging discussion of the radical deconstructive therapeutic approach he was using, and its underlying philosophical rationale. I found delightful and deeply moving Madigan's description of so-called 'therapeutic letter writing campaigns' which help clients to reconnect with their lost and (often institutionally) damaged identities (pp. 158-61). Such campaigns
are designed as counter practices to the dis-membering effects of problem lifestyles and the isolating effects of psychological discourses often create in people's lives. The letters form a dialogic context of preferred re-membering, re-remembering and meaning.(p. 160)
Drawing on Foucault's perspective on power, that seek a balanced view that takes account of structural effects as well as the agency of individual actors, Madigan makes the important point that it is at the least misleading simply to impugn the personal predilections of those who wield institutional psychiatric and psychological power: for
psychologists (viewed as persons) find themselves embedded and implicated in institutions and practices that they as individuals did not create and do not control - and they frequently feel tyrannized by it.... Psychologists are not the enemy, but they often have a higher stake in maintaining institutions within which they have historically occupied positions of dominance over their clients/subjects.(p. 161)
Finally, Madigan echoes a point that recurs throughout the book, that a socio-political perspective within therapy is crucial if it is not to become an individualising, self-serving (and -perpetuating) regime of truth:
Without a consideration of the cultural and socio-political context of any problem brought to therapy, therapy could be considered as merely reproductive of culture and its institutions and as such uncritical.... [T]he therapeutic questions we ask or don't ask,... the files we keep, the interpretations we make,... if left unknown, unwarranted, and unchecked, will act to help solidify traditions and techniques of psychology's power. (p. 162)
I was taken by surprise by the essentially pro-institutional professionalisation position taken by Fish (Chapter 4), who advocates institutional regulation (p. 68), arguing that 'The legal and administrative governance of psychotherapy... require constant attention and improvement' (ibid.). Fish seems to accept this viewpoint as an unproblematic given. It is ironic that his views are no doubt influenced by his own location within the culture of the US therapy world and its massively state-regulated environment, and that he fails to submit that very context to deconstructive gaze. Even if we accept (with Foucault) that 'power relations are not something that is bad in itself [sic]... I do not think a society can exist without power relations' (quoted on p. 67), it by no means follows from this that 'The therapist's power should be... monitored... by others (such as supervisors, consultants, and institutional regulators' (pp. 67-8, my emphasis).
Perhaps it is naive to think that all those who embrace a broadly deconstructionist, postmodern position in relation to therapeutic practice will necessarily generalise such views to the political, institutional organisation of the therapy field - particularly in the light of Foucault's surprisingly sanguine perspective on organisations, discussed earlier.
I am not nearly as confident as Lowe (Chapter 5) that 'psychotherapy will easily outlive the current interest in postmodernism' (p. 72) - no sense here of psychotherapy as a historically specific and ultimately transitory moment in human evolution. Lowe's otherwise outstanding chapter contains a view of post-postmodernism that sits very uneasily with both his own chapter and the rest of the book. He offers what seems to me to be a quintessentially (not to mention ironic) modernist view of postmodernism! - i.e. assuming it to be some-thing that will become part of history (p. 71), rather than a way of being which may well be inherently processual and ongoing rather than just another 'position' which will be transcended in due course of time.
The only chapter I struggled with was that by Byrne and McCarthy (Chapter 6). Even allowing for the challenging style that deconstructionist/feminist writing often takes, I found this chapter recurrently mystifying and stylistically obscure - e.g.:
Therapeutic discourse specifies a multiplicity of practices which hold possibilities to bring into view the different contents of colonization that circumscribe autonomy and, hence, a derogation of the primacy of ethics as 'self-esteem' in an individual life;
Within this approach therapeutic discourse becomes a vernacular exploration and dialogue, economized by the movement of ambivalence which narrativizes provisional and coherent identities from the force lines of multiple constituent discourses.(pp. 87 and 96)
Clearly this is a difficult and sensitive area, not least because it might be somewhat unfair to quote the authors out of context. I most certainly do not take the overly simplistic view that any worthwhile idea can necessarily be expressed in easily understood, everyday language. But equally, I am not un-used to reading this literature, so my own struggle with this chapter suggests to me that the authors could have made more of an effort to make their ideas more accessible. The following chapter, by Swan, certainly showed that feminist writing in this broad field does not necessarily need to adopt an obscure style. Thankfully, given the postmodernist literature's tendency to lapse into an almost studied stylistic obscurity, this was certainly the only chapter that presented any serious difficulties of comprehension for this reader.
Less than one-sixth of the book's content is devoted to case material. This felt like a not unreasonable balance, given the relative newness of the 'approach' being presented and the appropriateness of providing the reader with a thorough theoretical introduction to it. In future literature, though, it will certainly be important that the actual practice of 'deconstructive psychotherapy' be given far more attention. As Spears (1996: 4) has graphically written, 'Isolated critique, no matter how profound, cannot challenge an endless production of knowledge from the paper mills of positivism if this is not tied to new and impactful practices'.
Finally, there is no mention in Deconstructing Psychotherapy of so-called New Paradigm thinking (e.g. House 1997, 1999a, 1999b) - a rapidly growing movement that embraces, and is progressively crystalising around, an epistemologically sophisticated, anti-reductionist and often spiritually informed 'holistic-scientific' world-view - well represented by the world-wide Scientific and Medical Network (Lorimer 1998; Lorimer et al. 1999), which not only questions an ontology based on exclusively materialistic assumptions, but is prepared to take seriously areas of 'ineffable' human experience which traditional empiricist science invariably dismisses as 'unscientific' (House 1997c). It may well be that anything that smacks of 'the spiritual' would be anathema to most of the book's contributors - which would be a great shame, as there is surely great potential for major progress to be made from a cross-fertilisation of the kind of views represeneted in this book and the exciting strain of New Paradigm thinking that 'the New Science' is currently spawning (e.g. Clarke 1996; Laszlo 1996; Hitter 1997; Lorimer 1998; Wilber 1998).
[T]here is... the perpetual illusion that we have passed beyond the modern. (Parker 1998: 612, his emphasis)
Could it be... that the most important contribution to postmodern psychotherapy might be to serve as a harbinger of the 'not yet' - the fashioning of therapy discourses which move, ironically, beyond the modern/postmodern distiction? (Lowe, p. 83-4)
The widely and uncritically embraced duality of modernism/postmodernism is perhaps not only unhelpful and overly simplistic, but itself actually creates a polarised either/or debate which ironically replicates the very world-view which postmodern thinking at its best has pretensions to transcending (cf. Goss and Mearns 1997). As Parker (1998: 610) puts it, 'those who characterize themselves as "postmodern" are defining themselves against and within the terms of the debate laid down by the moderns'. On this view, any concept which is rooted in an emotionally driven process of reaction-formation (i.e. as a reactive, if understandable, counterweight to the excesses of modernity, distorting ego-dominated rationalism, technocratic positivism and the like) is itself very likely to be unbalanced (in this case, with an excess of 'emotionality', irrationality and disorder). The secret, of course, then becomes to step out of the polarised modernity/postmodernity duality, and into a more pluralistic, both-and way of being which can respect and work with difference and the in-between (cf. Goss and Mearns 1997; Samuels 1997). For Parker (1998: 612), 'There is a powerful discursive frame around our accounts of the modern and the postmodern, and we need to step outside that frame to be able to understand how it has gripped us'. As Goss and Mearns (1997: 193) have it, 'Perhaps we need a new logic - one in which apparent "opposites" can co-exist within a pluralist perspective'.
Perhaps we might then seek an alternative term, like 'transmodern', which reflects 'an ongoing transcending movement beyond', rather than a polarised, adversary position. Smith (1994: 408), for example, has also argued for the term 'late modern' as less misleading. On this view, which recognises 'modernity' as a necessary (albeit immature) stage in the evolution of consciousness, the transmodern will not reactively repudiate and condemn what went before as a 'mistake', but rather, will organically assimilate and build upon all that has gone before, but healthily transcend it into a more highly evolved level of consciousness.
It should be noted in passing that I have not given any attention in this review article to the thorny question of relativism in postmodernist and social constructionist approaches (for useful discussions see Spears 1996: 7-12; Parker 1998: 617-19). Certainly, critical realists are typically strongly critical of relativism (e.g. New 1996; Parker 1998) and its alleged politically paralysing effects. However, I cannot resist agreeing with Hare-Mustin at this point, when she writes that 'The notion that relativism is an evil to be avoided is itself a culturally embedded claim, shaped by political ends' (1994: 32).
Roger Lowe (p. 71) rhetorically asks whether, in the future, postmodernism will be looked back upon as 'a kind of watershed, that future generations will continue to look back to with pride as a major turning point in the betterment of therapy'. My own hunch is that the very rise of postmodernist, new paradigm and deconstructionist thinking marks a crucial moment in the evolution of human consciousness, it being an indication that we are as a species starting to approach a time when we will be mature enough to let go of the reassuring but hugely limiting (illusory) certainties of the ego-dominated, control-obsessed 'infant' of modernity, and let go into a 'transmodern' realm of experience of which we are as yet only dimly aware, still being so thoroughly caught up in the death throes of modernity. The journey from modernity through 'transmodernity' to whatever lies beyond it will not be an easy or straightforwrd one; and if - not unreasonably - we can expect therapy to take an active part in these momentous developments, then books such as this one will surely serve as leading-edge pioneering texts to help us through the transition.
Certainly, one message that comes over loud and clear in this book is that therapy simply cannot continue with its current conventional, predominantly modernist orientation: as Lowe has it,
[S]taying within the modernist repertoire may render psychotherapy obsolete in the sense that its emphasis on cultural adjustment tends to preclude its potential to assist in the construction of new relational possibilities.(p. 81)
With regard to postmodernism more generally, Lowe (p. 71) further points out that 'it can be bewilderingly difficult to gain a foothold, let alone a vantage point, for discussions of postmodernism'; and for Drewery and McKenzie (p. 148), 'there is a lot more work to be done investigating the application of post-structuralist ideas to therapeutic conversation'. This book shows quite conclusively that the most exciting, leading-edge thinking in the therapy sphere of the future will be critical, radical and deconstructivist.
In my view this book offers us an excellent beginning on the journey of 'transmodernity' - a journey which I believe to be essential if the future development of therapy as a helping practice is to be a healthy and viable one in what will in the future progessively become an increasingly 'transmodern' world.
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This article originally appeared in The Psychotherapy Review, 1 (7), 1999, pp. 322-32. The Editor is Ian Jones-Healey e-mail: firstname.lastname@example.org