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Deconstructing PsychotherapyReview - Deconstructing Psychotherapy
by Ian Parker, Editor
Sage Publications, 1999
Review by Chris Johns
Sep 7th 2000 (Volume 4, Issue 36)

It would seem unlikely that deconstruction-a theory that holds that persons lack stable identities, that knowledge lacks stable foundations, that the "expert" of knowledge lacks expertise, that social institutions such as psychotherapy perpetrate a kind of "violence"-would have anything to say that psychotherapists would want to hear. After all, therapists typically operate on the assumption that they are experts who can solve their clients' problems using reliable knowledge and methods. Yet, the aim of this book is to show that psychotherapists can, and should, adopt deconstruction theory and incorporate it into their practice. While this book offers some important theoretical proposals, and some promising results, readers may be frustrated by its theoretical indecisiveness and by a lack of clarity in the presentation.

The writers in this book advocate both a deconstructive kind of therapy and a deconstruction of therapy. The writers claim that the recent "postmodern, deconstructive turn" in psychotherapy, and its notions of "discursivity", "power/knowledge", and "difference," provides, in many cases, a more productive, even more ethical, kind of therapy. At the same time, the book attempts to "deconstruct" this very turn and even the very idea of "psychotherapy."

These essays are well-researched, professional articles. They are written by and for psychotherapists, psychologists, psychiatrists, and educators already familiar with the "narrative" turn in therapy, and already disposed to take a sociological approach. However, for those who are unfamiliar with the jargon of postmodernism, much of the writing likely will remain opaque. Too many of the authors are quick to adopt the jargon of postmodernism without clarification or criticism.

Despite both stylistic and philosophical shortcomings, the essays collectively manage to present a promising kind of therapy. For some readers the book may serve as a helpful introduction to some important postmodern themes. The common theme maintained throughout these essays is the postmodern insistence upon the socially constructed nature of human subjectivity. This means that both clients and therapists need to be aware of the way in which race, culture, gender, class, and political and societal institutions are powerful determinants of human reasoning, emotion, motivation, and development. This "postmodern turn" in therapeutic practice is meant to rectify the limiting and falsifying "modernist" emphasis on the self-willing, self-knowing, internally reasoning, subject. Along similar lines is the postmodern critique of authority and power, which here seeks to deflate the authority of psychotherapy by exposing its non-therapeutic interests. For example, we should question the therapist's need for power, the demands of the profession (such as HMO restrictions, DSM criteria), and beware of the therapist's tendency to cram the client's experience into a convenient and favored theoretical framework. The goal is to shift to a more client-centered therapy, or better yet, to a "dialogic repositioning" of the client-therapist relationship, in which the therapist relinquishes his/her role as "expert" in recognition of the client's "difference" from standard theoretical frameworks. To carry out this deflation of authority, deconstructive psychotherapy must "deconstruct itself," by continually submitting itself to its own deconstructive principles-if one may be permitted to speak of "principles" at all.

Indeed, the authors collectively maintain that the overarching problem for any therapy is a deep skepticism about principles and method-which is a philosophical problem for postmodernism as well. This results in the attempt to grapple with several paradoxes: subjectivity without a subject, therapy without an authoritative therapist, and a therapeutic method that refuses the "violence" of method. Even so, this skeptical stance relies upon several unchallenged assumptions that lead to an ethical imperative for the therapist. They are: that knowledge is essentially discursive; in other words, knowledge is a social construction of language and other social institutions; that anything socially constructed is subject to the conditions of power/knowledge; in other words, knowledge implies power and domination; Hence, knowledge is subject to revision; domination is wrong-therefore, to be ethical, we ought to remain skeptical.

Of course, one might counter these assumptions by claiming that knowledge does not entail power and domination, that language at least sometimes refers unproblemmatically to existing states of affairs, and so forth. But such would be the mistaken assumptions of a naive modernism, and so we can unproblemmatically dismiss them. Nevertheless, these authors maintain, this skeptical postmodern world at least requires that therapists, as well as clients, work to "un-know" themselves, rather than to fall into the trap of yet another "regime of power/knowledge" (a therapeutic method, or an accepted world-view). This position of "not-knowing" allows the therapist to remain open to the client's construction of experience. But then, what about the client's problem? And is this any longer therapy? Do we even need "therapists"? In other words, the overarching problem that a deconstructive therapy seeks to address is how to remain maintain this skeptical/ethical stance, without giving up the ethical obligation to help people who ask for it.

The therapist might begin by calling into question each of the terms 'problem', 'person', and 'help' in order to determine what sort of presuppositions the client (and therapist) may be illegitimately importing into each term. Clarification of terms and the dissolution of false beliefs is certainly not a novel approach, and cognitive therapists will find much to relate to here. But what sets deconstructive therapy apart is its attempt to include the social dimension as a major factor in the "constitution of the subject." Following Foucault in particular, the social dimension consists of a complex field of "power relations" that subject the client (and the therapist) to certain "regimes of control" which, in turn, promote and reify social behavior. In this light, therapy itself is in danger of becoming a "method of sociological control" which determines clients as "sick" and needing the help of authoritative "experts." Thus, clients are further disabled and victimized, while the institutional mechanisms in which the client is caught continue to run on their own momentum. If the reader begins to suspect that this emphasis on victimization risks increasing the client's sense of helplessness, the authors assure us that making clients aware of the social dimension makes them better able to adapt to social conditions and to make enlightened choices.

Overall, these essays are good at setting up the problems, but they are less successful at solving them. After a helpful introduction outlining the major themes, the book neatly divides into three general sections: theory, practice, and self-criticism. The five essays in the first section provide some key philosophical background, touching upon the works of Derrida, Foucault, and other therapists who have done work in the field. Deconstructive therapy can't be defined, its proponents say, because it is a "non-regulative" practice. Nevertheless, it can be characterized by its contrast with other therapies. Narrative therapy, for example, "still largely locates problems within an individual meaning structure," as opposed to a deconstructive "discursive approach," which seeks to examine the "socially constructed" practices in which clients are "positioned." The reader may notice the frequent use of the passive-voice instead of agent-active sentences. This is the result of a theory that emphasizes the impersonality of social constructions.

Therapists, as well as laypersons, will find the second section, "Deconstruction in Practice" much more enlightening, since its case studies effectively show just how these abstract theories should work. One essay in particular, "A Discursive Approach to Therapy with Men" is probably the most helpful, since it provides a lucid exposition of several illusive Foucauldian notions such as "discourse", "archive", "power" and "discursive practices." The exposition follows with an actual case study that clearly exemplifies the theory. The case involves a man who, feeling ashamed of his lack of manliness, comes to understand that his shame is reinforced by the "discourse of masculinity." This discourse is drawn from the "archives" of literature, philosophy, science, and religion-for example, the Romantic notion of men as "mad, bad, and dangerous to know"; the philosophic division between mind and body; the presumed "natural" and dichotomous scientific determinations of masculinity and femininity; and the religious claim that "God made them that way." These "ways of speaking" become "discursive practices" when they reinforce certain ways of behaving and thinking while denying alternatives. Masculine shame and humiliation, then, become ways of socializing men to adopt certain roles.

More disturbingly, shame and humiliation lead to acts of masculine rage. Having reached an understanding of discursive practices, the client was able to reveal to the therapist that as a teen he had raped his girlfriend after she "humiliated" him for his lack of "manliness." The rape further deepened his sense of shame, making it difficult for him to have constructive relationships with both men and women. Further exploration examined what the therapist called "the discursive practices of accountability and responsibility," rather than the discourse of shame. This included the client having to carry out the legal and moral obligations of his having essentially destroyed this young woman's life. Perhaps controversially, this approach holds all men, not just rapists, complicit in the act of rape. This is because an act of rape is in part the result of a discursive atmosphere that promotes rape in subtle but powerful ways. For this client, the result of therapy was that his humiliation-induced rage converted to disappointment. He became aware that these discursive practices "were the intentions of other men," not him. They are about "what men do to other men in general, which meant that "he no longer looked for revenge." In keeping with the critical demands of deconstructive therapy, the essay ends with a female therapist questioning the male therapist (the author) about some possible problems with this approach. Both therapists, however, overlook a disturbing but logical implication of this approach, which is that women, as participants in the discourse of masculinity, are abstractly complicit in their own rape. Perhaps this results from a therapeutic approach that puts too much weight on the social dimension of subjectivity. Despite this problem, this essay remains the clearest example of how deconstructive therapy is supposed to work.

The other case study essays were not as illuminating, however. An essay on feminism and Foucault, good for its emphasis on the way in which women's socialization requires a therapeutic approach specific to women, was also good for emphasizing that deconstruction does not lead to victimization, but rather provides an empowering tool for liberation. Unfortunately, the essay undermines its credibility by offering a composite case study, leaving the reader to wonder whether the author constructed the case in such a way as to contrive a successful demonstration. Another case study deals with therapy and religious faith, where the difficulty is that the therapist must often respect the clients faith in the providence and intervention of God, while encouraging the client's sense of self-direction and agency. In such cases the therapist should maintain "an attitude of respectful curiosity" toward the client, rather than assume the imposing role of all-knowing expert. The therapist effectively demonstrated this attitude through a series of carefully worded questions; but this largely amounted to a sort of client-centered, cognitive therapy, and the reader may wonder what was "deconstructive" about it.

The third section, containing two essays, attempts to stay true to the deconstructive project by deconstructing its own project; that is, by submitting deconstructive psychotherapy to a critical examination of itself. The goal is to attain the status of "not-knowing," which prevents a particular therapeutic approach from becoming yet another oppressive form of power. Yet, surprisingly, this objective is called into question when a therapist reports that his client is feeling oppressed by deconstructive therapy. "What Judith [the client] found most oppressive was the therapist's insistence that she was being subjugated by her circumstances, by the politics of capitalism and gender . . . that our 'saving tools' for her, were, oppressive." Surprisingly, this criticism was not pursued. Yet the author suggests that whatever form oppression takes, presumably even the form of deconstruction, the therapist is obligated "to respectfully join the client in their struggles." Does this mean dropping the discourse of oppression for the sake of the client? We aren't told. But the author does warn against the therapist's own power fantasy. "Along with the dream of emancipating the client goes the fantasy of overthrowing the monstrous system, more or less single-handed. Almost a fantasy of omnipotence . . .?" But once again, the reader is left with a sense of indecisiveness.

The other essay in this section challenges the notion that there is anything like "psychotherapy" in the first place. It is impossible to define, practically inseparable from other similar activities, and has been proven to be no more effective than non-specific factors such as "warmth of the therapist, trust, hopefulness, a constructive nature of conversation, feeling understood, etc." In this sense, therapy is merely a "discursive resource for well-being." Yet as a discursive resource, the task for the therapist is to rescue it from the deadness of facts, closure, and analysis by "re-imagining" and "re-metaphoricizing" it. This is a nice idea, but what does it mean exactly? The essay, and book, ends with a rather vague and disappointing call for "regaining not-understanding" by "cultivating the art and value of life." But that might be done in any number of ways.

This kind of skepticism about principles and frameworks in therapy should be familiar. Some 30 years ago, existentialists based their skepticism of therapeutic frameworks on the absolute uniqueness of the subject (person). Deconstructionists base their skepticism on the absolute dissolution of the subject. Wisdom, as Socrates said, is the ability to know that one does not know. The ancient skeptic, Sextus Empiricus, wrote "he who suspends judgment about everything which is subject to opinion reaps a harvest of the most complete happiness." The overall stance of "not-knowing" taken in this book is a commendable effort to remain open to possibilities, especially since the effectiveness of any particular therapeutic method (whether medical or non-medical) remains an open question.

However, maintaining this suspension of principles without dissolving into vagueness and self-refutation is a problem for this book. It conveys an overriding fear of commitment stemming from the fear of becoming yet another power structure. The book is best when it is honest and lays out the unchallenged assumptions of deconstruction. They are: that persons often think, feel, and behave in accordance with societal expectations and constraints; and that clients are empowered (dare we say "self-actualized"?) by becoming aware of the domination effects of societal institutions-including the institution of psychotherapy. Of course, these claims require more clarification and justification than this book seems able to manage; but it does convincingly persuade us that these "postmodern" sociological factors need to be included in standard therapeutic practice.


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