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Society for Exploration of Psychotherapy Integration SEPI XXIXth ANNUAL MEETING BARCELONA 2013

Integration in Constructivist Psychotherapy: A New Proposal

Danilo Moggia

Master in Cognitive Social Therapy and Master of Research in Behavoir and Cognition

Department of Personality, Assessment and Psychological Treatments Faculty of PsychologyUniversity of Barcelona

1. IntroductionPostmodernity constituted a zeitgeist in western culture that proffered the fall of the predominant narratives and discourses of

truth and knowledge. For postmodernists knowledge is a construction delimitated by the social, political, cultural and historical

moment in which it takes place. In this zeitgeist, there are two theoretical epistemological systems that manifest themselves in

the field of psychotherapy: constructivism and social constructionism. Both have a mutual and reciprocal influence, and

generate specific psychotherapeutic models. Constructivism has influenced in the development of different schools of therapy:

cognitive therapies (Kelly, 1995; Guidano, 1994; Goncalves, 2002); experiential therapies (Greenberg and Pascual-Leone, 1996;

Ecker and Hulley, 2002); systemic family therapies (Tomm, 1988; Keeney, 1994; Andersen, 1991) and brief therapies (Watzlawick

and Nardone, 1995; De Shazer, 1990; OHanlon, 1990). On the other hand, social constructionism allowed the development of

specific psychotherapeutic models that cant be classified in a particular traditional school of therapy like collaborative or

narrative therapies (Anderson and Goolishian, 2000; Epston and White, 1996). To develop a model that proposes a methodologyfor an integrated practice of psychotherapy, for who calls "constructivist therapist", it becomes necessary to address the

different dimensions of human experience and meaning, that different schools of psychotherapy (inside constructivism and

social constructionism) address separately, in a comprehensive therapy meta model, from a meta theory like constructivism

could be considered.

Rather than propose an integrative model in addition to the many there are, this proposal aims to provide a methodology that

allows different constructivist therapists to integrate elements of work (theoretical, methodological and technical),

outstandingly addressed by different therapeutic approaches separately, without the therapist feeling like a "sinner" for

betraying his or her school of theory and without falling into a meaningless technical eclecticism.

2. Theoretical Proposal: A Constructivist Integrative ModelFor constructivism, as human beings we endow meaning to our experiences actively. Each constructivist psychotherapy model,

according to their theoretical school, emphasizes one aspect only of human experience as central to the construction of

meaning: phenomenal experience and affective processes for experientialists, thinking processes for cognitivists and relational

processes for systemics. Meanwhile, for socio constructionism, every experience happens through a broader sociocultural

dialogic framework. What is proposed here is to pick those aspects of human experience, addressed separately, as different

dimensions of meaning from which experience is constructed and referenced. Five dimensions of meanings construction are

henceforth proposed: experience (experiential, implicit and bodily affective processing of information), explanation (explicit,

digital and linguistic processing of information referred to lived experience), constructs (dichotomous distinctions of contrasts

that give account the experiences and explanations), narrative (temporal and historical storying that connects different

experiences in a broader metaphorical framework, functioning as a life script) and acts (role or behavioral repertoire displayedfrom the dimensions of meaning in a given context). Each of these dimensions relate to and are co-determined by the others, in

a series of relations of reflexivity. All of these dimensions, considered as a System of Meanings as a whole, are developed within

2 hierarchical systems that determinate: a biological matrix within a sociocultural matrix. The first refers to the biological

structures and processes that determine us as specie and organisms (human genetics, anatomy, physiology and ecology), and

the second relates to socio discursive processes taking place in the social and cultural environment in which we operate and

construct. Inherent to this matrix is that the acts are developed and enacted in front of an audience, which validates or

invalidates them, thereby allowing such action to continue to be enacted or not over time in that particular context or scenario.

In this sense, the psychotherapeutic act constitutes a symbolic performance co-constructed between therapist and consultant,

which allow the reorganization of meanings for the consultant.

3. The Psychotherapeutic PracticeThe psychotherapist approaches the consultant willing to listen and understand their stories, their narratives. Inside the told

stories the experiences, explanations, constructs, acts and metaphors of the consultant appear, to which the therapist will be

particularly attentive. The aim of constructivist psychotherapy is to help the consultant, in a collaborative relationship, to change

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their system of meaning or develop new meanings and new stories that allow problem resolution. Therapist and consultant

work together through conversation and dialogue in the generation of new possibilities for life. In the conversations, the

consultant can refer their experiences with emphasis on a particular dimension of meaning included in the model, which can be

read as a marker that invites the therapist to work at first, from that dimension. At the methodological level, psychotherapeutic

practice is informed by research in Common Factors and by Patient-Focused Psychotherapy Research. From this, a methodology

that divides the psychotherapeutic process in stages has been developed. These stages, for pedagogical purposes, are explained

in a linear way, but within the psychotherapeutic process are not necessarily linear, although they tend to be. Each stage has a

goal in the process, a guiding principle and a therapeutic competence that the therapist must be develop to ensure compliance

with the purpose of the stage. At the same time, each stage is associated with the use of certain techniques that are the tools

that will allow the therapist to achieve the goal of the stage, appearing as a behavioral indicator of the deployment of the

competence required by the therapist. Even if the early stages are more important at the start of therapy, the competences

there required must be continuously unfolding along the entire process. It should be noted that the therapist does not approach

the consultants problem with a theory in advance about how it should be dealt with, but rather therapist and consultant work

from the Theory of the Problem and the Theory of Change that the consultant has (Miller et al. 1997), from his or her own

System of Meanings. A stage that cuts across all the psychotherapeutic process is also included: the constant evaluation of

progress, goals and therapeutic alliance. This implies that the consultant at the beginning of each session, reports his or her

general welfare (through ORS) and if they are approaching their goals (through TEPP), and at the end of each session the

therapeutic alliance is evaluated (through SRS 3.0). This provides the therapist with immediately feedback that allows him or her

to accommodate the therapy to the consultant and assess whether the therapy is working or not according to outcomesresearch and expected treatment response.

4. DiscussionThe proposal has been developed shows promising applications in various fields. First, in relation to the clinic practice, allows to

the therapist to work with different elements of human experience in a comprehensive manner, adjusting its own practice from

results reported by the consultant. Secondly, in research field, provides specific methodologies to research at different levels:

At micro-processes level:o It can be used the dimensions of meaning proposed by the model as categories for content analysis of the

consultants discourse, allowing us to understand their meaning construction and the change of these

constructions throughout the therapeutic process.

o It can be analyzed the therapist interventions, regarding the identification of markers in the consultantsspeech, as a proposal for work with some specific dimension of meaning of the model. Therapist interventions

can also be analyzed as a behavioral indicator of a deployment of a particular competence and the use of

certain technique.

o It can be analyzed the appearance of Innovative Moments or Return to the Problem Markers within the speechof the consultant (M. Goncalves, 2002), as qualitative indicators of evolution of change during the process.

At processes an outcomes level:o It can be correlated the micro-processes indicators aforementioned with changes in scores measurements

along therapy.

o Progress can be assessed with the consultant's own targets (TEPP), being able to correlate longitudinally, thesemeasurements with the measurements of outcome (ORS) and alliance (SRS 3.0).

At outcomes level:o It can be researched in line of Expected Treatment Response, estimating progress curves with aim to

determinate if the therapeutic process is adjusting or not to the expected response. This allows to the

therapist accommodate to the consultant through immediately feedback.

Third and finally, in field of psychotherapists training, the model allows to divide the learning process into systematized stages,

each linked to the development of specific therapeutic competences.

In summary, the model shows promising lines of applications for which it is necessary to do research.

Contact: Danilo Moggia / +34 - 651 169 836 / danilomoggia@gmail.comEsta obra est licenciada bajo la Licencia Creative Commons Atribucin-NoComercial-CompartirIgual 3.0 Unported. Para ver una copia de esta licencia, visita

http://creativecommons.org/licenses/by-nc-sa/3.0/.