I have written about the problems of literalism in previous posts and I am well aware that the reader of those posts could leave with the mistaken impression that I see literalism as a problem afflicting only religious fundamentalists. Nothing could be further from the truth. In fact, I regard pervasive literalism in both theory and technique as the single most destructive trend in modern clinical psychology. There are many ways to be a fundamentalist. There are many ways to attend only to surface manifestation and appearance of things while ignoring substrates of the manifest that symbolically imbue those surfaces with deeper meanings. This is true whether we are speaking about a biblical text, a political constitution or a client's communications in psychotherapy.
Chris Allan recently reported on a study that examined client perceptions in reaction to therapists' handling of requests for therapist self-disclosure. I haven’t checked the original article, but what I gather from Allan’s report, the effects of self-disclosure were evaluated based solely upon manifest client reactions to the handling of self-disclosure requests.
When we believe that the most important meanings of client narrative are to be found at some manifest, literal level in the 'text' of the client’s narrative, we make the same mistake a fundamentalist makes in taking a literalist or ‘strict constructionist’ approach to a text. We eviscerate the richly symbolic, often surprising and sometimes disconcerting meanings that lie within the substrata of symbolic constructions. When we fail to hear the underlying meanings in client narratives, we fail to hear what is most difficult for both the client and the therapist to hear and coherently reformulate in words.
If the therapist is quiet and allows for an uninterrupted space for the client to construct narrative during the session, the therapist can listen quietly to the underlying tensions, themes and conflicts that animate the client’s unfolding narrative creation. If the therapist is prepared to listen in this way, it becomes possible to form hypotheses about the underlying meanings of that narrative.
When the therapist believes there is sufficient data to support his or her understanding of the underlying meanings of the client’s narrative, the therapist can offer an interpretation that deconstructs the client’s manifest narrative in a way that attempts to addresses the underlying unspoken disturbing meanings that are condensed and symbolically displaced within the client’s manifest narrative.
Quite often (some would say always), the therapist is a pivotal player in that underlying narrative, whether or not the therapist is actually referenced directly in the manifest client narrative. This does not seem unreasonable when we consider that the therapist and client are the two parties to a relationship in which an ongoing co-created narrative is unfolding. The manifest content of the narrative can be understood much as the manifest content of a dream can be understood. The manifest characters and themes are symbolic representations of more troubling unconscious perceptions, images, conflicts and affects. In the therapeutic relationship, as in all relationships, all parties have conscious and unconscious perceptions and conflicts that arise within the relationship. In psychotherapy, these will be spoken of symbolically during the co-construction of narrative in the therapeutic interchange, assuming the therapist does not interfere with the unfolding narrative communication by erecting obstacles through the use of frequent questions, interruptions and other ‘interventions’ that divert or obliterate the emergence of symbolic communication.
In the study of therapists’ management of requests for self-disclosure, the author's reliance upon manifest client reactions to the handling of the requests to evaluate the effects of that handling is, at best, naïve. Relying upon the manifest, immediate reactions of a client to evaluate the effects of therapist management of self-disclosure is akin to believing that all one needs to judge a parent’s decision to grant a child’s request is the child’s rationale for the request and the child's manifest pleasure or frustration over the parents’ decision. While the example of a child might seem condescending toward clients, I use it because it is an understanding that most of us are more prepared to accept conceptually when we speak about children. Somehow we appreciate that the manifest is not all in children, but we often fail to appreciate that the same is true for adults, including ourselves as therapists. We naively presume that the immediate, manifest impressions conveyed in our words, represents the most truthful, wisest part of ourselves, even though our immediate, surface reactions are often closer to the reactions of an inexperienced child.
The example of a parental 'intervention' with a child also underscores the seriousness of the error made when we confuse manifest expressions of relief, gratification or frustration with deeper forms of confirmation or disconfirmation of therapeutic interventions. Far from intending condescension toward clients, I believe that it is often the therapist who is least willing to deal with the deeper, underlying (often accurate) meanings of the client's response to a therapeutic intervention. Therapists are human beings who operate within the same internal and external intersubjective systems as their clients.
Therapists are prone to resistances, just as clients are prone to resistances. We, as therapists, cannot honestly pursue deeper meanings and truths with our clients, if we, ourselves, are not personally and fully committed to honestly pursuing thorny, unpredictable, often disconcerting deeper meanings in all facets of our lives. Yielding to socially pervasive pressures to accept conventional, two-dimensional, surface meanings is to withdraw from the search for deeper truths before we’ve even begun to look.
I would propose, then, an alternative to the study’s reliance upon manifest client reactions to evaluate the management of self-disclosure requests. Rather than relying upon the analysis of aggregated data from a number of different therapists paired with different patients, therapists can endeavor to listen more seriously to each client’s narrative as a symbolic representation of unconscious perceptions and conflicts, even after an intervention has occurred (in the case of the study, the intervention is the therapist’s handling of the request to disclose).
Looking beyond the client’s manifest rationale for anger, displeasure, satisfaction or relief, we can examine the client's more deeply meaningful, and perhaps troubling, reactions to an intervention as they are symbolized in the narrative that unfolds subsequent to the intervention. Unconscious client perceptions of the intervention, for better or for worse, are often contained in the symbolism of the narrative that follows the intervention. I would find it more helpful to read more analyses that rely upon this type of qualitative analysis than a dozen aggregate analyses of manifest client responses to an intervention.
In summary, then, the therapist listens to the client’s narrative without interrupting until the therapist believes there is sufficient data to interpret the underlying meaning of the narrative. Next, the therapist offers an intervention (the hypothesized meaning of the narrative). Finally, the therapist listens to the emerging narrative that follows the intervention. This narrative usually emerges after the client has made brief direct comment on the intervention, although clients often don’t even bother with the manifest direct commentary on an intervention. They may simply move into symbolic narrative commentary, particularly when they realize that the therapist is willing to hear what lies beneath symbolic language.
The process is highly data driven and interpretive hypotheses are not assumed to be confirmed by virtue of either the client’s manifest reactions or the therapist’s belief in some superiority of the therapist’s understanding over that of the client. Rather, the client’s unconscious reactions tell a more revealing story of how the intervention as been received.
In my experience, I have found that therapists often have considerable difficulty with such an approach. They are, essentially, fundamentalists committed to the illusion of some manifest, literal, singular meaning of client narratives. Like the fundamentalist who calls creationism 'science' while rejecting mountains of scientific evidence, many psychotherapists refuse to admit data that would jeopardize their superior position and sense of certainty in the therapeutic relationship. While some talk a good game of interpretation, it is very difficult to consistently listen to the client and remain attentive to unconscious meaning and build interpretative hypotheses from the underlying meaning of client data. When the client’s unconscious perceptions are accurate and hold disturbing insights into the therapist, it becomes even more difficult to listen to the symbolic disconfirmations of our interventions.
When we work in this way, we will fail often. It is only then that we can honestly appreciate the client's struggle and the nature of the obstacles we and our clients face in taking up the honest pursuit of meaning that all of us face as finite, limited human beings in a vast dynamic creation. No one ever said this job would be easy.