Construing Psychotherapy Outcomes

Fri, 12 Apr 1996 09:03:00 -0500 (CDT)

John and others:
Your comments about attempting to *practice* personal
construct therapy in the context of managed care shows (to me at
least) that the real world of practice is often quite different
from theoretical treatises. I suspect that most therapists are
like you, mixing and matching from a variety of theoretical
What therapists, even the leaders in the field, do and what
they say they do is often quite different. My favorite anecdote
about this is being at a conference and observing a demonstration
of prototypical cognitive-behavioral therapy. A leader in
experiential therapy walked in late, and at the end of the
presentation asked a question with the assumption that the
treatment was *interpersonal* and not cognitive-behavioral. The
point is that cognitive-behavioral therapists (the good ones)
often use the alliance and the relationship in their treatments,
even though they may not explicitly say this (Steve Hollon for
example claims not to think about the relationship, but his
relational skills in forming an alliance rival -- in truth, are
superior to -- our "interpersonal" therapists). Likewise, I've
seen many good interpersonal therapist who sneak in some damn
good cognitive-behavioral reframes.
Certainly, personal construct therapy *in practice* is also
not theoretically purified. As you imply, John, the question is
at what point do the inconsistencies among approaches become
intolerable? You say, "I try to be extremely sensitive to a
client's idiosyncrasies while meeting societies goals" and that
using personal construct theory this way feels "exceptionally
manipulative." This illustrates the real plight of therapists in
the field -- the meat and potatoes of working with real people in
a social context. The only way to avoid this sort of dilemma
would be to discontinue accepting fees or third party
reimbursement (George Kelly did this; most of us can't afford
this option).
My guess is that in practice there are subtle manipulations
by most (all?) personal construct therapist, while recognizing
the need not to be heavy-handed. To return to the example of
extraterrestrial abduction, I would claim that the personal
construct therapist would wish to try to construe that construing
process. Yet, can't we say (in our bones) that we know damn well
that this is a "delusion" and that in truth we wish to move such
a client away from such constructions? In other words, we can
respect the sovereignty of another's construing process while
believing our own constructions (right Jon?). Yet, I would also
claim that we are all subtly manipulative, in spite of our best
attempts, at wooing others to accept our constructions (call it
countertransference if you want). The best therapists are aware
of this, as you seem to be aware of your "manipulations". The
question that is hotly debated now (curiously in psychoanalytic
circles, not so much in personal construct circles (except for a
few like my former mentor)) is whether it is best to avoid these
"manipulations" or encourage them and disclose them (e.g.,
Searles). This is a great issue!
OK, enough pontificating for one day! Work awaits!
Tim Anderson
Department of Psychology
Vanderbilt University
Nashville, TN 37240