Postmodernism and Psychotherapy

            The impact of postmodernism on psychology is, at first, more evident than its influence on psychotherapy. Nonetheless, it is important not to discount how postmodernism is changing the face of contemporary psychotherapy. This essay provides an overview of several important postmodern trends and implications for psychotherapy.

The Postmodern Psychotherapies
            The most obvious ways postmodernism influences psychotherapy is through the development of therapy orientations that are distinctively postmodern. A number of therapies can be seen as falling into this category.
            Narrative therapy often is cited as the quintessential postmodern therapy. This approach to therapy emerged in the postmodern period from a postmodern epistemology. It blends social constructivism with personal constructivism to create an understanding of people and therapy that is decidedly postmodern. However, being the quintessential postmodern therapy doesn’t mean that it is the only or best postmodern approach. Several other approaches have taken decidedly postmodern trends.
            Contemporary Psychoanalysis (often referred to as Relational Psychoanalysis) set itself apart from earlier approaches to psychoanalysis (e.g., Freudian, Object Relations, Self Psychology) by becoming distinctively postmodern (Hoffman, Hoffman, Robison, & Lawrence, 2005). Social constructivist and intersubjective approaches to psychoanalysis generally are categorized as variants of Contemporary Psychoanalysis.
            Existential and Humanistic psychotherapies began showing strong postmodern trends before postmodernism was a well-known term (Hoffman, 2004). Both of these approaches emphasize subjectivity, limits in the human ability to know, and utilization of multiple ways of knowing.
            These are just a few of the more evident postmodern trends in psychotherapy. However, most psychotherapy orientations have variants which are embracing and integrating postmodern ideas.

Psychotherapy Research and Outcome Studies
            New trends in Evidence Based Practice also demonstrate postmodern themes. Psychology, particularly clinical psychology, spent many years attempting to become a hard science. This often involved deluding itself about how objective and true psychological research could be. Empirical and neurological research was the champion of this movement. In the end, this enterprise failed, often making the field of psychology look quite foolish.
            In the attempts to become a hard science, psychology developed the empirically validated treatment (EVT) and empirically supported treatment (EST) movements. These promoted manualized treatments, the therapist’s knowledge and skill, and self-report ratings of psychological health as the key to successful therapy. Over time, increasing evidence from meta-analyses and literature reviews provided strong evidence of the flawed ways of EVT and EST movements. Instead, they suggested that client factors and the therapy relationship were the most important factors in successful outcome (Horvath & Bedi, 2002; Lambert & Barley, 2002; Wampold, .
            Ron Levant, during his tenure as president of the American Psychological Association, encouraged the development of Evidence Based Practice. This alternative to the EVT and EST approach included a broader understanding of what was evidence of successful therapy outcomes. Levant (2005) encouraged practitioners from various approaches to join in the discussion of how Evidence-Based Practice should be defined. It is a concern that if practitioners do not actively seek to define this broadly, it could end up being defined the same as the ESTs.
            A broad understanding of Evidence-Based Practice could include multiple sources of knowledge (i.e., an epistemological pluralism) as valid in supporting psychotherapeutic practice. It also opens doors to qualitative research, expert opinion, and well-established theory as valid sources of support for the effectiveness of a treatment modality.
            Support for this trend can also be seen in the push for multimethod research. The American Psychological Association Press recently released its first book on multimethod research (Eid & Diener, 2005). Similarly, other recent books seek to integrate qualitative and quantitative research methodologies (Creswell, 2002; Tashakkori & Teddlie, 1998; Thomas, 2003). Furthermore, more researchers are acknowledging the limitations of research as an objective source of knowledge that can be generalized across people and settings.

Understanding Psychotherapy in a Different Light
            A modernist perspective purports that therapy evaluated through objective scientific research can determine the efficaciousness of a therapy modality. Furthermore, modernism advocates that treatment modalities with empirical support are therefore superior. Postmodernism calls this premise into question on a number of grounds.
            First, postmodernism questions the ability of empirical research to be objective. Different types of research are more appropriate for evaluating different approaches to therapy (Hoffman, 2005). The measurement must be consistent with the theory; otherwise epistemological problems threaten the validity of the research.
            Second, while all psychotherapies share the goal to decrease symptoms, at least to some degree, and to increase the quality of life, they disagree on what this looks like. In other words, not all psychotherapies seek the same ends (Hoffman, 2005). This makes it very difficult to consider which approach to therapy is best for which client.
            A third concern relates to client values. If different therapies have different values and lead to slightly different ends, then which approach to therapy is best for a client is, in part, a values decision (Hoffman, 2005). In other words, both values and effectiveness need to be considered when making choices about which approach to psychotherapy is best.
            The field of psychotherapy has often looked foolish by engaging in petty debates over which approach to therapy is best. Postmodernism responds by stating this is not even the right question! It is not possible to determine which therapy is superior because it depends upon too many client and therapist factors. Furthermore, when therapists are making the determination of which approach is best, they are taking responsibility away from their clients and imposing their values system upon them. Instead, therapists should work with client to help them decide which therapy approach best fits the client’s goals and values.

Postmodernism and the Client Condition
            Rollo May (1991) purports that a leading reason clients enter therapy today is because of the loss of sustaining myths. According to May, myths are not something which are false, but rather something which cannot be proven to be true. As such, all psychotherapy orientations, religions, and worldviews are myths.
            This idea applies directly to the postmodern condition. Although most clients entering the therapy room have little knowledge or understanding of postmodernism, it still influences their lives on a daily basis. The postmodern deconstruction of modern myths creates a sense of anxiety and lack of meaning for many individuals. Even if postmodernism is an improvement upon modernism, it is natural that the transition will create anxiety. However, this anxiety is likely to remain largely in the realm of individual and cultural unconscious.
            Therapists working with clients in the postmodern age need to be aware of the impact of postmodernism even if their clients are ardent modernists or premodernists. No one escapes the influences of such a drastic paradigm shift.

Postmodernism, Power, and Psychotherapy
            In modern and premodern approaches to therapy and counseling, the therapist had the privileged position. It was the therapist who determined appropriate therapy outcomes, defined the approach to therapy, and led the way. There is a significant power differential between therapist and clients in this perspective.
            Postmodernism de-emphasizes the hierarchy implicit in modern and premodern psychotherapies. Additionally, the postmodern therapies tend to enlist clients as co-creators and co-facilitators in the therapy process. Similar to many feminists approaches, postmodernism tends to identify the hierarchy and power differential as a social construction rather than an absolute reality. As such, the power differential can still be exploited and, in fact, increases the potential for exploitation.
            Influences from feminist, humanistic, and existential theories are fairly evident in postmodern psychotherapy’s conception of power and hierarchy. Although all of these approaches recognize that power differentials inevitably develop and that it is important for the therapist to recognize these, they differ in their perspectives on how to approach them. Many of these approaches believe that part of the therapy process is deconstructing these artificial hierarchies and power structures.

Conclusion
            Postmodernism is changing the fact of psychotherapy in many ways that often goes unnoticed to practitioners. As we continue to move into the postmodern era, these influences will only strengthen making it irresponsible for therapists to not understand these changes.

References

Creswell, J. W. (2002). Research design: Qualitative, quantitative, and mixed methods approaches (2nd ed.). Thousand Oaks, CA: Sage.

Eid, M. & Diener, E. (Eds.). (2005). Handbook of multimethod research in psychology. Washington, DC: American Psychological Association.

Hoffman, L. (2004, August/September). The danger of the "truth." AHP Perspectives, 22-24.

Hoffman, L. (2005). Depth psychotherapy and the empirically supported movement: Critica lissues.  Retrieved from the Depth Psychotherapy Network web site: http://www.depth-psychotherapy-network.com/Professional_Section/Empirically/
Hoffman_EST_1.htm

Hoffman, L., Hoffman, J., Robison, B., & Lawrence, K. (2005, April). Modern and postmodern ways of knowing: Implications for therapy and integration. Paper presented at the Christian Association for Psychological Studies International Conferences, Dallas, TX.

Horvath, A. O. & Bedi, R. P. (2002). The allilance. Research summary on the therapeutic relationship and psychotherapy outcome. In J. C. Norcross (Ed.), Psychotherapy relationships that work (pp. 37-69). New York: Oxford University Press.

Lambert, M. J. & Barley, D. E. (2002). Research summary on the therapeutic relationship and psychotherapy outcome. In J. C. Norcross (Ed.), Psychotherapy relationships that work (pp. 17-32). New York: Oxford University Press.

Levant, R. (2005, Feb). Evidence-based practice in psychotherapy. Monitor on Psychology, 36, 5.

May, R. (1991). The cry for myth. New York: Delta.

Tashakkori, A. & Teddlie, C. B. (1998). Mixed methodology: Combining qualitative and quantitative approaches. Thousand Oaks, CA: Sage.

Thomas, R. M. (2003). Blending qualitative and quantitative research methods in theses and dissertations. Thousand Oaks, CA: Corwin Press.          

Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum Associates.

Added December, 2006
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