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0:05
My name is Jonathan Raskin, and I'm excited about my new book, Constructive Psychotherapies.
0:17
And so this is what it looks like. And so what I'd like to do today is share some of the ideas that I discuss in the book.
0:28
And in the book, I discuss how we can make therapy constructive
0:34
by grounding it in constructive theory. And for many of you, constructive theory may be unfamiliar. So let me spend a little bit of time unpacking what it is and why I think it offers a useful approach to therapy. So constructive therapy is not a singular theory or method.
0:59
The term constructive therapy is plural for a reason.
1:03
Any therapy can be considered constructive if it a presumes people construct accounts of the world. And B views therapy as an undertaking to help clients revise those accounts and experiment with new ways of living and understanding.
1:23
So the key to constructive therapies is helping clients to re construe. That is, to experience and to make sense of events in novel ways that open fresh possibilities. So to that end, constructive therapists employ a variety of clinical strategies.
1:46
That encourage clients to test new ways of construing and behaving.
1:52
This often involves raising clients awareness of their roles in the meanings that they rely on.
2:00
While simultaneously encouraging experimentation with alternative constructions. Such experimentation requires that clients behave differently to see where these shifts lead.
2:15
So in the few minutes that I have today, I'm going to talk about constructive therapy techniques that are grounded in George Kelly's personal construct theory.
2:25
So, as Kelly once put it, whatever exists can be construed. But how do we help clients to re construe,
2:34
like most constructive therapies, personal construct therapy isn't technique driven.
2:40
However, personal conflict therapists have developed a variety of interventions and assessments that serve as helpful additions to the constructive therapy toolkit. And I'm going to discuss two personal construct therapy strategies adopting a credulous approach and having clients enact fixed roles.
3:03
So let's start with the strategy of adopting a credulous approach. The notion of a credulous approach comes from personal contract therapy. It's a stance of openness and acceptance that's adopted by a clinician in order to understand how the client's presently experiencing the world.
3:23
Adopting the credulous approach means accepting what clients say, even when it doesn't fit with the presumed facts of the situation.
3:33
And here's a little quote from George Kelly about that. He said, from a phenomenological point of view, the client, like the proverbial customer, is always right.
3:46
And so the credulous approach communicates respect and curiosity about the client's experiential reality. In this regard, it is very much in keeping with the emphasis on empathy and positive regard found in person centered humanistic therapy. However, personal conflict therapy is typically more directive than person centered therapy. The personal contract therapists actively asked clients how they understand the world. And Kelly actually gently poked fun at therapists
4:18
who felt the only way to obtain information from clients
4:23
was through indirect methods such as non directive listening, free association, dream analysis or elaborate assessment techniques. Kelly's advice to therapists was quote if you do not know what is wrong with a person, ask him. He may tell you, I like that quote. So in addition to actively listening and working to comprehend client concerns, this slide here shares some questions that a therapist can use to credulous inquire about clients presenting complaints.
4:57
So for example, you might ask the client with what problem would you like help? When were these problems first noticed? Under what conditions do they first appear
5:09
and what corrective measures have been attempted? What have you done to address the problem? What changes have come with treatment? Right. Therapy for example, or the passing of time. And then you might also ask under what conditions are the problem most noticeable. And then lastly under what conditions are they least noticeable.
5:28
And so credulous listening in conjunction with questions like these serves as a kind of controlled, get compassionate, phenomenological approach to understanding the client from the client's own point of view. So, for example, Elena was a 25 year old Latina woman who presented with feelings of anxiety and depression. She felt she was, quote, going crazy, but she couldn't figure out why. I work to create, listen, and understand Elena's experience.
6:03
She was in a long term relationship with her living boyfriend Garth, and his angry outbursts were something that Elena attributed to her failures as a supportive girlfriend.
6:14
As part of incredulously understanding Elena's experience. She provided the answers to the questions I just shared a moment ago. So, for example, with what problems would you like help? She said, feeling anxious and depressed and spending most days in bed. When I asked her when were the problems first notice, she said
6:34
six months ago, which was two months after she moved in with Garth.
6:39
Right. Under what conditions did these problems first appear? Whenever Garth and I had a big argument. What corrective measures have been attempted? I stopped seeing my friends without Garth and made sure to be there when he got home, because he didn't like it when she would go out and do things without him. Right. And so you ask these different questions, and you then can try to understand the client and the client's experience. So through credulous elaborating a ladies
7:08
complaint, it became clear to both of us that her anxiety and sadness weren't due to her failures as a girlfriend,
7:17
but due to her despair over Garth's behavior and her fear that she would have to suffer with it indefinitely.
7:25
Although it took several months more of therapy and planning, elaborating Elena's problem was very, very helpful. She eventually broke up with Garth, moved into her own apartment, and she began developing new and more supportive relationships. Importantly, using a credulous approach doesn't mean accepting all client utterances unquestioningly or as literal truths. However, it does mean that the therapist endeavors to comprehend client meanings rather than dismissing them
7:59
as irrational falsehoods or reflections of underlying pathology.
8:04
So, as my doctoral advisor, Franz Epting once said in taking a credulous stance, quote, it's very important that the counselor should not try to make everything fit logically or confirm conform immediately to the facts as externally perceived.
8:20
In this respect, constructive therapy differs from forms of CBT that focus on correcting client's faulty thinking
8:29
from a constructive orientation. Irrational beliefs are ones whose logic and meaning to the client. The therapist has yet to grasp.
8:39
When a client expresses ideas that don't square with those held by the therapist, it's the therapist responsibility. And George Kelly's words to quote, lay out both versions side by side and not erase the client's version in order to replace it with the quote. True version. So constructive therapists invite clients to consider alternative constructions or to entertain additional evidence without privileging their own account as the final, healthy and correct one.
9:09
So consider the case of Melanie, a 40 year old white female who presented with obsessive thoughts about her late cat.
9:17
Melanie had long lived with her elderly and verbally abusive father. When the opportunity to move into an apartment of her own came up, she jumped at it. However, because the apartment didn't allow pets, she brought her cat to an animal shelter. She was expecting them to give the cat away and get it a new home. But instead, the cat was put to sleep. Feeling distraught and responsible for the death of her cat, Melanie reneged on the apartment. She was convinced that her cat's death was the result
9:47
of her selfish desire for independence
9:51
and an apartment of her own, away from her father. So rather than directly confronting Melanie's beliefs as irrational, I offered an alternative construction for her to consider.
10:03
After listening empathically to her latest lament about her selfishness, I remarked, that's one way to look at it. But I have to admit that I don't see it. That way. This piqued her interest and led to the following exchange. What do you mean? She replied, cautious but curious. Well, I said, you pursued your own happiness for the first time in your life. Unfortunately, things didn't work out, and you concluded that your cat's death meant you weren't supposed to be happy.
10:30
From where I sit, that doesn't make sense. Melanie paused and then asked, you see it differently? Yes, I said. I think the part of you that wants to be happy finally got strong enough to put your needs first, but then through some bad luck, things didn't work out as planned. That was unfortunate, but it doesn't mean the part of you that feels you deserve to be happy was wrong. Melanie thought long and hard about this. She kind of laughed and she remarked, you might be right.
10:59
No. In this exchange, I incredulously listened to and accepted Melanie's construction of events. I didn't treat her construal as irrational as wrong. Or is indicative of some underlying disorder. Yet neither did I accept her interpretation unquestioningly. As critics of constructive therapy insist is required.
11:21
Based on the erroneous assumption that viewing accounts as constructed requires valuing them all equally.
11:27
The myth about constructive approach is that you just have to accept any old construction, no matter what it is. So I invited Melanie to entertain an alternative construction of events, one informed by my understanding of how she made sense of things. Credulous understanding enhances the therapist's authority to challenge their clients, after all. And here's a quote from Trevor. But a famous constructivist therapist.
11:53
He said, unless we can understand exactly why the loss of a pet was so devastating,
11:57
neither good advice nor well meaning interventions are likely to be helpful.
12:05
All right, so that's a bit about the credulous approach. Next let's let's turn to having clients in fixed roles.
12:12
Right. Fixed role therapy builds on personal contract psychology's metaphor of the person as scientist. Fixed role therapy asks clients to play roles that diverge in important ways from how they presently construe themselves. The goal is for them to suddenly realize, if I act in a different way, I can be different.
12:33
I can be different from what I think I am. I can change. So the process usually starts by asking clients to write a self characterization sketch of themselves in the third person from the perspective of a sympathetic person who knows them very well. To help clients with the task, they're sometimes asked to write their self characterization in the form of a letter to the therapist about them sent by a close friend.
13:00
For instance, a 20 year old college student named Gigi drafted the following self characterization sketch, in which she described herself as shy and socially avoidant.
13:11
Here's the here's the sketch she wrote. Gigi is a nice person, but other people often don't know this because she's painfully shy. She's so shy, in fact, that she will work hard not to talk to unfamiliar people, or hard to not talk to unfamiliar people, as doing so makes her nervous. It's come to the point where the other students at her college have probably given up on her, seeing her as a socially avoidant person who refuses to make eye contact or speak up,
13:38
either because she lacks confidence or doesn't care about others. Gigi's social difficulties are made worse because she despises small talk, even though she has a lot to offer outside of occasional socializing with a few close friends. Gigi spends most of her time alone. As a result, she's lonely and depressed.
13:59
Now after clients self share their self characterizations, their therapists revise these sketches, altering them in ways that encourage experimenting with new forms of acting and living. So the result is what we call a fixed role sketch, written like the client's original sketch. In the third person, but given a different name than the client and altered in important ways. The fixed role sketch should push the client to act in a novel way, but not be so different
14:30
from what the client usually does, that implementing it would be too difficult.
14:35
So Gigi's therapist provided her with the following fixed role sketch of Sammy, a private person who still engages comfortably when she wants to with others. So here's the sketch. Sammy is a nice person who sometimes feels anxious about socializing with others. However, Sammy doesn't let this stop her. When she encounters someone who's interesting to her or when she feels lonely, she pushes herself to engage socially, or at least to not avoid others. Sometimes this means going either by herself
15:05
or with a friend to campus social events. Sammy cares about other people, even if the prospect of socializing is sometimes stressful to her. She also has enough self-confidence to see small talk and the occasional awkwardness of social gatherings as necessary evils for making and enjoying new friends. This perspective has generally worked for Sammy, although she enjoys her alone time. Sammy has a reasonably active social life and only sporadically feels lonely,
15:36
so after being provided a fixed role sketch by their therapists, clients are asked to play their fixed role. Characters in daily life. Typically for two weeks. Continuing with the previous case. Gigi was asked to act like Sammy for a two week period. This included going to a campus party, something that Gigi would never do in her next therapy session. Gigi reported a remarkable experience. She attended a party like Sammy would, initially standing alone by the door.
16:07
A few people came over and engaged her in discussion. They offered her a drink. They asked her to dance. And to her? Great surprise. Despite some lingering apprehension, she found herself enjoying the party. She continued periodically doing this throughout the rest of the two weeks, going to different parties, and she kept doing it even after the fixed role experiment ended.
16:32
Sammy's more social comportment, which was initially very foreign and frightening to Gigi, had been absorbed into Gigi's self construction. This is the power of fixed roles. They reduce resistance to testing new behaviors.
16:47
So fixed role therapy was also helpful with Susan, a 24 year old woman who presented her therapy with feelings of generalized anxiety, insecurity about her physical appearance, and shame over still being a virgin.
17:03
Susan often felt others responded to her negatively. Her therapist provided Susan with the fixed role sketch of Mary Jones, whose attributes were ones that Susan valued but wasn't embodying in her life. The Fixed Role sketch read as follows Mary Jones is a friendly young woman whose open and frank with the people that she meets. She enjoys giving to these people and the feelings of companionship she has with them. She sees herself as united with her fellows, as part of the world with them.
17:34
Mary is a down to earth kind of person, and most of the time she's calm and relaxed. She's able to be patient with the people she knows and is not very critical of them.
17:45
Mary is also searching and inquisitive. She can be forceful when the occasion demands it and lively too. Mary is the kind of person people like to know.
17:57
So Susan was asked to play Mary Jones between sessions. Now, initially she found this very difficult. I couldn't possibly be like that, she exclaimed. But her therapist simply encouraged her to try out the role occasionally, just to see what might happen. After some stops and starts, Susan eventually tried the role with the checkout woman at the supermarket,
18:20
and she was surprised by how much more warm and friendly the supermarket checker became. A few weeks later, Susan tested the rulebook at parties where she didn't know most of the attendees, as well as once at work with some colleagues. According to Susan's therapist Linda Viney, quote, what Susan learned from this experimenting was that if she thought and felt about herself differently, which she found she could do. People reacted to her differently. So this insight
18:52
helped her construe in new ways that better allowed her to anticipate and predict interpersonal engagements with others. And this caused her less anxiety in those situations.
19:04
So, in conclusion, constructive therapies have a great deal to offer, both experienced and budding therapists. These therapies provide a way to make sense of client problems, and it's a way that uniquely balances insight with action. Clients can gain insight when they become aware of the taking for granted. Ways that they construe their lives. Yet constructive therapies move beyond merely talk.
19:35
They also stress and encourage action.
19:39
Viewing behavior as an experiment. Constructive therapists invite clients to do something differently to explore novel possibilities. And these results can prove transformative. They can open new and unanticipated ways to meaningfully experience self, others, and the world. So insight and action together constitute the fundamentals of change. And they're not mutually opposed. So constructive therapy is, I think, our ideal for therapists who like to innovate.
20:13
Write therapists who prefer creative to doctrinaire or scripted interventions are the ones who are most likely to find themselves drawn to constructive perspectives. Although certain clinical strategies work with many clients, therapy always has to be tailored and adapted to the client at hand. In this regard, constructive therapists view therapy therapy very similarly to how Heraclitus Heraclitus, the ancient Greek philosopher, viewed rivers,
20:41
a person never steps into the same river twice, and likewise a therapist never conducts the same therapy or even the same therapy session twice.
20:51
Every client is different and requires an original approach. No matter how many one size fits all therapy manuals are devised, every therapy experience is unique.
21:05
So thank you for listening to me, and hopefully this brief presentation provided a preview of the kinds of issues covered in the book, and I'd be happy to answer any questions that you might have. So thank you very much.
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