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Applying the Visions of
Reality to a Case of Brief Therapy
Stanley B. Messer
Rutgers University
Correspondence concerning this
article should be send to
Stanley B. Messer, Rutgers
University, Graduate School of
Applied and Professional
Psychology, 152 Frelinghuysen
Rd., Piscataway, NJ 08854-8085
Portions of this article appear
in Messer and Warren (1995) and
Messer and Woolfolk (1998) and
were presented at the meeting of
the Society for the Exploration
of Psychotherapy Integration in
Madrid (July 1998).
Author's affiliation: Graduate
School of Applied and
Professional Psychology, Rutgers
University, Piscataway, NJ
Key Words: visions of reality,
brief therapy, integrative
therapy
Abstract
The "visions of reality"
refer to assumptions about
the nature and content of
human reality and have been
used to describe different
genres of literature as well
as psychoanalytic,
behavioral and humanistic
modes of therapy. In this
paper, four visions--the
tragic, romantic, comic and
ironic--are applied to a
single case, spelling out
the way in which each can
direct the focus of a
therapist’s attention to
different aspects of a
client’s problems. Each
vision can also influence
the process of therapy and
its goals. Keeping the
several visions in mind can
broaden both the therapist’s
and the client’s view of the
client’s life situation and
problems, thereby opening up
possibilities for
integrative work. The paper
also spells out the shift in
visions of reality that is
necessary when conducting
brief versus long-term
therapy.
Applying the
Visions of Reality to a Case of Brief
Therapy
In a
series of articles and
chapters (e. g., Messer
& Winokur, 1980, 1984,
1986), Winokur and I applied
a narrative typology labeled
"visions of reality"
(Schafer, 1976) to three
major schools of therapy,
namely, psychoanalytic,
behavioral, and humanistic.
We attempted to illuminate,
within the framework of
these models, the way in
which narrative forms
provide a template for the
construal of human
experience and the
possibilities and
limitations of the therapy
change process. The typology
includes the romantic,
tragic, ironic, and comic
genres and has been
elaborated upon most
extensively by the literary
critic Northrop Frye (1957,
1965), and by Roy Schafer
(1976) in connection with
psychoanalysis. The
conclusion we arrived at was
that the disparate visions
to which these three modes
of therapy adhered set
limits to their integration
especially given the nature
of their practice in the
1970s and early 1980s. Along
with sounding a cautionary
note regarding integration,
however, we discerned a
trend on the part of
proponents of these schools
of therapy to incorporate
elements from the other’s
predominant vision, making
the prospects for
integration appear brighter
(Messer, 1986; Messer &
Winokur, 1986).
After
reviewing the ways in which
the visions can serve as a
template to understand
underlying thematic
structures in different
theories and techniques,
this paper will try to
demonstrate that it is both
possible and desirable to
keep in mind each of the
visions in treating the same
case in order to appreciate
fully the client’s
complexity. That is, they
can be usefully brought to
bear in therapy to highlight
the different dimensions of
an individual client’s
experience, or by
recognizing how each may
best apply in certain
clients or circumstances.
This effort also has the
effect of opening up
possibilities for
integration that therapists
may not have considered
previously.
Andrews
(1989), in a conceptually
rich, integrative paper
argued that "when we
structure a personal style
or therapeutic outlook
around a single vision, we
risk becoming
one-dimensional
caricatures...Each style or
vision is an ingredient in
the full human experience,
and we need them all" (p.
812). Pointing to the
dangers inherent in
emphasizing any one vision,
he contended that we, as
therapists, must recognize
the predominant vision of
reality held by our clients
and help them identify and
broaden the stylistic
options they have chosen. In
this connection, but now
from the therapist’s side,
it is interesting to note
Vasco’s (1998) finding that
therapists who made use of
different epistemic modes
(empiricism, rationalism,
and metaphorism) were found
to be more flexible in terms
of their therapeutic styles
(directive, reflective, and
encouraging
self-examination). The same
therapeutic flexibility may
very well be true for those
therapists who make use of
the several visions of
reality.
In what
follows, I will first review
the visions of reality and
how they apply to the
current practice of
psychoanalytic, cognitive
behavioral, and
humanistic/experiential
therapies. A case will be
presented, followed by how
the visions might be applied
to this case, highlighting
how different features of
the client’s problems and
personality are most readily
captured by one or another
vision. In addition I will
refer to how each vision
affects the process or
techniques of therapy, and
the outcomes most consonant
with it. Because the case
was conducted as a brief
psychodynamic therapy, I
will also show how the
visions of reality of
psychoanalysis are altered
in this mode of therapy.
The
Visions of Reality
The
Romantic Vision
From
the romantic viewpoint, life
is an adventure or quest in
which each person is a hero
who transcends the world of
experience, achieves victory
over it, and is liberated
from it. "It is a drama of
the triumph of good over
evil, of virtue over vice,
of light over darkness
(White, 1973, p. 9). The
romantic vision idealizes
individuality and what is
"natural." It advocates
free, uninhibited, and
authentic self-expression:
"The fully developed
individual is characterized
by true spontaneity, by the
richness of his subjective
experience" (Strenger, 1989,
p. 595).
The
romantic vision is
fundamental to humanistic
psychotherapy (Perls, 1969;
Rogers, 1961) within which
life is viewed primarily as
an adventuresome quest.
Humanistic and experiential
psychotherapists emphasize
the cultivation of emotional
sensitivity and
expressiveness and seek to
develop in their clients
spontaneity, creativity,
authenticity, agency, and
experiential intensity
(Bohart, 1995; Greenberg,
Rice, & Elliott, 1993).
Here is how some current
practitioners of
humanistic/experiential
therapy (Watson, Greenberg
& Lietaer, 1998)
describe important subtypes
of this model: "One of the
central tenets of Gestalt
therapy, like existential
therapy, is to facilitate
the individual in becoming
more authentic" (p. 19); "In
process-experiential
therapy, an important task
is to bring emotions and
their associated action
tendencies into awareness"
(p. 20). Regarding
existential therapy, "one of
the primary objectives is to
have clients face the givens
of existence and confront
the attendant anxiety so
that they can learn to live
more authentically and
responsibly in the moment
(p. 18)".
Operating
within this romantic,
Dionysian sensibility,
humanistic psychotherapists
tend to see "adjustment" to
society as undesirable.
Society is viewed as a
straitjacket, a constrictive
entity that causes us to
lose touch with our feelings
and our inner selves, hence
limiting our capacities for
self-actualization. The
creative artist, rather than
the businessperson, is seen
as embodying the epitome of
human functioning (Messer
& Woolfolk, 1998).
Psychoanalytic
therapy also partakes of the
romantic vision, but with a
different emphasis. In
stressing an exploration of
the unconscious, the
irrational and the unknown,
psychoanalysts are
influenced by the romantic
attitude. Psychoanalysis
also is conceived of as a
journey, a quest for
redemption. The therapeutic
process encourages a
regression away from
everyday reality and into
the world of dreams, free
associations, and fantasies.
Unlike humanistic therapy,
however, it envisions more
obstacles en route
and is much less optimistic
about the possibilities of
ultimate self-actualization
and liberation. Nor does it
value as strongly as do some
humanistic therapies, acting
"naturally" and, what it
might term,
narcissistically.
In
contrast to both the
psychoanalytic and
humanistic therapies,
cognitive behavior therapy
is more reality-oriented and
practical than it is
romantic. Problems are
defined operationally,
measured objectively, and
treated expediently. Therapy
is conceived of as a
psychotechnology (Woolfolk,
1992) that can be
systematized and manualized.
The
Ironic Vision
The
ironic attitude is
antithetical to the romantic
view. It is an attitude of
detachment, of keeping
things in perspective, of
recognizing the fundamental
ambiguity of every issue
that life presents to us.
Each aspect of a person's
behavior may represent
something else, be it a
dream (latent vs. manifest
content), a symptom (a
displaced or distorted
wish), or an interpersonal
interaction (hostility
disguised by sugary
kindness). The ironic vision
has in common with the
tragic vision an
understanding that there are
inherent difficulties in
human existence, that life
cannot be fully mastered,
that its mysteries cannot be
truly understood.
Schafer
(1976) tells us that the
ironic perspective in
psychoanalysis "results in
the analysand’s coming to
see himself or herself as
being less in
certain emotional respects
than was initially
thought--less, that is, than
the unconscious ideas of
omnipotence and omniscience
imply" (italics added, p.
52). This is in contrast to
humanistic/experiential
therapy where the goal is
for clients to see
themselves and life’s
possibilities as greater or
more than before
therapy.
Psychoanalytic
therapists adopt the ironic
attitude in therapy when
they take a position of
relative detachment. They do
so in order to detect the
flip-side of the client’s
utterances and behavior--the
hidden meanings,
contradictions, and
paradoxes. By contrast, in
their therapeutic demeanor
cognitive behavior
therapists and humanistic
therapists are more apt to
be friendly,
self-disclosing,
transparent, and affectively
expressive, which may lessen
the possibility of
discerning irony. Cognitive
behavior therapists also are
more likely to take client
complaints at face value and
accept their stated
therapeutic objectives
without critical inquiry
into them (Messer, 1986).
Humanistic therapists tend
to accept most client
feelings as authentic
expression. It is the
essence of the ironic
posture to shun credulity,
to take nothing for granted,
and to assume that nothing
is exactly as it seems on
the surface. The credibility
granted to the client by
both humanistic and
cognitive behavior therapy
is contrary to the ironic
mode.
Gold
and Wachtel (1993) view
cyclical psychodynamic
theory (Wachtel, 1997) as
falling within the ironic
vision, replacing Freud's
tragic vision (discussed
next). They emphasize the
irony in patients' creating
an "unwitting repetition of
past maladaptive
relationships and traumatic
experiences in the very
search for new and
productive interactions" (p.
61). By avoiding anxiety,
individuals close themselves
off from the possibility of
new experiences and new ways
of interpreting inner states
and interpersonal
encounters. They seek out
others who will not require
them to change, and the
ironic result is the
continuation of the anxiety
they have been trying to
avoid--the opposite of that
which was consciously
intended.
The
Tragic Vision
The
tragic and ironic visions
are linked insofar as they
both include a distrust of
romantic illusions and happy
endings in life.
Furthermore, these
sensibilities favor
reflection and
contemplation, whereas the
romantic and comic views are
more action oriented.
Tragedy, however, unlike
irony, involves commitment.
In a tragic drama, the hero
has acted with purpose and
in so doing has committed,
at least in his or her mind,
an act causing shame or
guilt. He or she suffers by
virtue of the conflict
between passion and duty
and, after considerable
inner struggle, arrives at a
state of greater
self-knowledge. In the
tragic vision the
limitations of life are
accepted--not all is
possible, not all is
redeemable, not all
potentialities are
realizable. The clock cannot
be turned back, death cannot
be avoided, human nature
cannot be radically
perfected.
Many
aspects of traditional
psychoanalysis fall within
the tragic vision. The
demands of the drives are
seen as fundamentally at
odds with the constraints
imposed by society and the
processes of socialization
(Wolitzky, 1995). People are
viewed as caught within
early fixations, which
themselves are subject to
repression and thus lie
beyond their ken. The
fixations result from our
sexual and aggressive nature
and the intrapsychic and
interpersonal conflicts such
a nature gives rise to--
discord from which we never
can be entirely free. For
the psychoanalytic
therapist, the price of
self-knowledge is a degree
of suffering. The outcome of
psychoanalytic treatment is
not unalloyed joy and
happiness or all obstacles
overcome, but rather the
fuller recognition of what
one’s struggles are about, a
fuller understanding of the
conditions and limitations
of life within which one
must work.
Both
humanistic/experiential and
cognitive behavior therapies
contain fewer tragic
elements than
psychoanalysis. Humanistic
psychology views people as
fundamentally good,
innocent, and unfallen. Its
straightforward optimism
about human prospects for
self-actualization is
diametrically opposite to
the somber and complex
realism of the tragic view.
Traditional cognitive
behavior therapy also is a
fundamentally optimistic,
practical technology to
modify feelings and behavior
rather than to understand
and accept them (but see
Jacobson, 1994, for a
different view).
Recalcitrant life situations
simply require ever more
powerful, scientifically
validated therapy
techniques. The inner
reconciliation based on
self-knowledge described in
psychoanalysis is not
featured as a therapeutic
goal.
The
Comic Vision
Whereas
in tragedy things go from
bad to worse, in comedy the
direction of events is from
bad to better, or even best.
Although there are obstacles
and struggles in a comedy,
these ultimately are
overcome and there is a
reconciliation between hero
and antagonist, between the
person and his or her social
world. Harmony and unity,
progress and happiness
prevail. For this reason,
dramatic comedies often end
with festive celebrations.
Note that the conflicts
portrayed in a comedy are
ones between people and the
unfortunate situations in
which they find themselves,
and not the kind of inner
struggles or implacable
oppositions encountered in
dramatic tragedy.
In
cognitive behavior therapy,
conflict may be ascribed to
external situations or
internal forces that can be
mastered through application
of therapeutic technology
(Fishman & Franks,
1997). Cognitive behavior
therapists are more
interested in the direct
alleviation of suffering
than in the exploration of
internal struggles. A phobia
of crossing streets, or a
complaint of lack of
assertiveness or anxiety is
approached with a spirit of
optimism and attacked
head-on with empirically
tested procedures and
educative instruction. By
contrast, struggles over
separation issues
symbolically expressed in
difficulty crossing streets,
or over fear of aggressive
impulses in the unassertive
client, are explored by the
psychoanalytic therapist not
only with the goal of their
remediation (psychoanalysis
does have some comic
thrust), but also with the
view that increased
consciousness of one’s
condition is itself
worthwhile.
Humanistic/experiential
therapies do not strive for
happy endings in quite the
way cognitive behavior
therapists do, nor are they
as basically contemplative
about inevitable warring and
discordant factions of the
mind as is psychoanalytic
therapy. But the humanistic
approaches do emphasize the
substantial possibilities
for gratifying impulses that
Kris (1937/1952) has
described as an essential
aspect of the comic view.
For them, freer, more
joyful, laughter-filled
existence is attainable. The
true self one comes to
discover and liberate in
humanistic therapy is not
one fraught with struggle,
nor is it one seeking
reduction of tension, but
rather is an authentic self,
free from conditions of
worth, in touch with natural
organismic valuing, and
satisfied with life’s
enormous possibilities for
self-enhancement.
I now
present a case to illustrate
how the visions of reality
might be applied to an
actual clinical situation.
The Case
of Mrs. B.
Mrs. B
is a 45 year old, married,
Jewish woman who has been
feeling poorly for some
time. For the past two
months, she has experienced
frequent crying spells, a
lack of interest in people
and activities, and a wish
to run away from it all. She
acknowledged some suicidal
ideation but has no plan of
action or history of suicide
attempts. She failed to meet
the criteria for Major
Depressive Disorder, but
rather was diagnosed as
Depressive Disorder, Not
Otherwise Specified (311;
DSM-IV)
When
asked what had happened two
months ago, Mrs. B.
responded that she had
learned from her 16 year old
daughter that she had been
sexually molested over a two
year period by her older
brother when they were
younger. While her daughter
acknowledges feeling
depressed, she has not been
willing to say more about
what occurred, and has
recently started seeing a
therapist at her mother’s
urging. Mrs. B. says she
both wants to know and
doesn’t want to know what
happened. She feels that she
can’t tell her husband about
it and is reluctant to
confront her son for fear
that revealing this
information will "destroy
the family." However, she
finds herself having
antagonistic feelings toward
her son that are beginning
to "leak out". Mrs. B has
tried to come to grips with
the revelation about her
children, but finds herself
unable to do so, complaining
that she was "falling fast
and would soon explode".
Over the past 6 months, she
has taken several kinds of
antidepressants which did
not help her. Two weeks ago
she started on a course of
Prozac.
A
significant background
stressor, which has
contributed in an important
way to her feeling poorly,
is her medical condition.
She suffers constant,
intractable pain from lupus,
arthritis, and collagen
vascular disorder, has high
blood pressure and is
fearful that her life will
be shortened by these
ailments ("Lupus is like a
slow cancer that will
eventually attack my
organs"). Walking is painful
for her and she is unable to
climb a flight of stairs.
What worries her is that she
will end up in a wheelchair.
In addition, she had a
breast removed five years
ago when it was discovered
that she had cancer, and
received chemotherapy for a
period of time. She was told
that she has a genetic
marker for cancer. One of
the side effects of the
several medications that she
takes has been a weight gain
of 50 lbs. that very much
distresses her. Not
surprisingly, she worries
about dying, wonders if
there is a God, and "what
comes next, after you die?"
Another
ongoing stressor is that her
husband lost his job a year
ago and has not been able to
find regular employment. He
has started his own
business, which is seasonal,
and it is not yet
financially solvent. In
addition to working full
time in an administrative
position in a large company,
Mrs. B. tries to help her
husband run his business.
The
client describes her husband
as a quiet, decent man, much
like her deceased father,
who lacks self-confidence
and is both self-critical
and very critical of others.
He is passive, not a
go-getter like her, she
says, and he can’t handle
too much at once. He tends
to minimize her medical
problems which leaves her
feeling that she has to face
them alone. She would like
him to be more affectionate
to her and to be more
helpful around the house,
especially given her
physical difficulties. She
does most of the household
chores herself--cooking,
cleaning, handling
bills--and rarely asks for
help since she doesn’t want
to provoke arguments and
risk her marriage coming to
an end. It is likely that he
is depressed, she says, and
he is also taking Prozac.
Mrs. B
was married once before, and
divorced about 15 years ago.
She describes her first
marriage as physically and
emotionally abusive, in
which she was hit and pushed
around a great deal. Her two
children are from that
marriage. Her son is married
and her daughter is in high
school, but is not
performing well. She
commented that she feels
like she is a mother to
everyone but gets nothing
for herself. She feels
guilty if she is not making
others happy, yet is
frustrated because she
doesn’t get to do what she
wants to do. She wonders if
she is trying to make up for
her longstanding feeling of
not being good enough.
Mrs.
B.’s father died 10 years
ago when he was 60 and she
was 35. They had a close
relationship and she still
misses him. Her mother tries
to be helpful to her but
"babies me too much." In
this vein, her mother lets
her know that the proper
role of a wife and mother is
to cook, clean, and
otherwise attend to all the
physical and emotional needs
of her family. When she was
growing up, her mother was
very strict with her, and
critical of her.
Mrs. B.
is well regarded at work,
seems to take pleasure in
the challenges there, and is
striving to advance herself
by taking workshops in her
area of expertise. She tends
to miss some days at work
due to her medical
condition, but is able to
take work home. She is
engaging to be with and,
despite her many problems,
conveys a degree of strength
and perseverance under very
adverse circumstances. She
has hobbies in the artistic
realm that also give her
pleasure.
Visions of
Reality in the Case of
Mrs. B.
The
Tragic Vision
Here we
will try to imagine how the
visions of reality might
influence the angle of
regard of the therapist at
different points along the
way in therapy. In terms of
content, the tragic
vision would highlight the
irreversible features of
Mrs. B.’s life condition.
She has reared her children
and can undo little of
whatever damage has accrued
from the sexual contact
between them. She must
struggle with the attendant
guilt of not having noticed,
or not wanting to notice,
what was happening at the
time, and in what way she
may have been to blame. She
has no easy choice facing
her, whether it is to let
sleeping dogs lie or to
confront her children with
their deeds. To do the
former is to allow the
wounds to fester and
possibly to spoil her
relationship with her son.
To do the latter is to risk
a permanent rupture among
several members of her
family. From the tragic
perspective, the piper must
be paid or, stated
differently, there is no
free lunch.
Her
medical condition is chronic
and is slated to worsen. One
cannot wish this away, in
the spirit of the romantic
vision, or avoid the daily
reminders of her condition
evidenced in her pain and
difficulty walking. Her life
possibilities are no longer
what they once were, that
is, she may have to accept
that she will not get the
college degree she wanted,
or rise to greater heights
in her company, simply
because her physical
condition won’t allow it.
From
the point of view of process
and technique, the
tragic view calls for
exploration, reflection, and
contemplation, which is most
typical of psychoanalytic
and humanistic approaches.
The therapist participates
in the client’s problems in
a manner similar to the
audience’s participation
with the hero in a tragic
drama. Just as the audience
responds with pity and
terror based on an
identification with the
hero’s plight, the therapist
responds empathically to the
client based on resonance
with similar tragic themes
or echoes of them in his or
her own life. The therapist
also recognizes the ubiquity
and universal nature of the
kinds of conflict, anxieties
and suffering that the
client faces. Both
understanding and treating
them within the tragic
vision call for an
introspective and subjective
stance with a thoroughgoing
internal focus.
In
terms of expected
outcomes, the tragic
vision stresses limitation
based on circumscribed human
possibility. At best, one
exchanges neurotic misery
for everyday unhappiness
(Breuer & Freud,
1895/1955). Even the
successfully treated person
will be subject to
occasional reversals which,
depending on how chance and
fate play themselves out,
can range from mild to
severe. There may continue
to be an ongoing struggle
with the same issues,
although hopefully at a
diminished level. Both the
therapist and Mrs. B. come
to realize, within the
tragic view, that the best
she can do is come to accept
her fate with a certain
degree of equanimity--a calm
acceptance with a modicum of
despair.
The
tragic view, in isolation
from the leavening provided
by the other visions of
reality, can lead to an
overly gloomy and
pessimistic therapeutic
stance. The danger here is
in subtly encouraging the
client to wallow in her angst
leading to passivity which
would allow opportunities
for action to pass her by.
Some of this leavening comes
from the therapist keeping
in mind the comic vision
which is taken up next.
The
Comic Vision
As in
comic drama, one might view
the content of Mrs.
B’s problems as situational
obstacles to be overcome
through direct action. The
problems can be framed as
maladaptive interpersonal
interactions between her and
her children, and her and
her husband which are
potentially ameliorable.
Similarly, her husband’s
employment and business woes
can be approached in a
problem solving mode that
could improve Mrs. B.’s mood
and reduce her anxiety. Ways
can be proposed to improve
her physical condition as
well. With respect to technique,
within the comic vision one
would approach Mrs. B. with
a sense of optimism and
can-do. True, she is
depressed and life is not
easy for her, but mental
health practitioners have
available tools and
techniques to make things
better. The client’s
depression can be alleviated
with the appropriate
medication which will at
least lift her mood, and/or
she can be administered an
empirically supported
treatment for depression
such as cognitive or
interpersonal therapy (Task
Force, 1995). Her distorted
beliefs and maladaptive
interpersonal relations may
be thereby improved. Perhaps
certain behavioral stress
reduction techniques,
appropriate diet, and an
exercise regimen would also
help control her condition,
albeit not cure it.
Regarding
the relationship to her
husband, she can be taught
assertiveness training to
get more of her own needs
met, and/or communication
skills to improve their
marriage. In this way a
reconciliation between our
"hero’" and her "antagonist"
could come about. With
respect to her children,
perhaps the situation can be
cognitively reframed as
their experimenting with sex
to prepare themselves for
adult life (as is accepted
in some cultures), thus
alleviating or eliminating
her guilt.
Outcomes
within the comic vision
are decidedly more
optimistic than within the
tragic. There is an
increased pragmatic
capacity to perform social
roles more adequately, in
this case Mrs. B’s role as
wife, mother, and
employee. Happy endings
are anticipated, including
improvement in coping
skills, such as Mrs. B’s
way of handling her
illnesses, and increased
social assertiveness in
Mrs. B. posture toward her
husband.
The
limitations or danger in
this approach is "in the
assumption that the
therapist knows best and
that the client merely has
to follow advice in order to
lead a satisfying life"
(Andrews, 1989, p. 808),
which can remove too much
responsibility from clients
for charting their own
course and destiny. The
comic vision can also induce
expectations for cure in the
client that are unrealistic,
leading to disappointment.
The
Romantic Vision
Within
the romantic vision, the
creative, fulfilling and
adventurous aspects of life
are emphasized, even if
there are temporary
setbacks. In Mrs. B.’s case,
she has artistic interests
that can be capitalized on
to help her live a more
satisfying life. Regarding
the process of
therapy, Mrs. B. can be
helped to strive to fulfill
her potential in the work
sphere and to develop her
artistic talents as
expressions of her true
self. Her inner life of
fantasies and daydreams can
be explored with the view of
encouraging her to see
herself as a complex,
striving individual who is
not defined solely by her
illnesses or her current
life condition. She can be
helped to live more in the
moment than in the past. In
general, the therapist,
acting within the romantic
tradition, holds an attitude
of curiosity and openness to
unexpected developments in
the client, characteristic
of the humanistic therapy
tradition.
With
respect to outcomes,
Mrs. B.’s drama is one of
the opposing forces of light
and darkness, which,
consonant with this vision,
can be settled favorably.
The therapist’s
unconditional acceptance of
her, and her enhanced
agency, will help to bring
her along to newfound
pleasures in life and new
possibilities. The danger in
a one-sided emphasis on the
romantic vision is of
overplaying the creative
possibilities and ignoring
the client’s and life’s
realistic limitations.
Clearly, not all fantasies
can be realized nor all
aspirations fulfilled.
The
Ironic Vision
This
vision provides a corrective
to the romantic vision in
particular. The process
or technique of
therapy within the ironic
vision calls for the
therapist to be skeptical of
all he or she sees and hears
from the client. It
encourages a questioning,
challenging, even
confronting attitude towards
what the client says and
does. The ironic vision also
predisposes the therapist to
keep the three visions in
balance. Things may not be
as bad as they seem for Mrs.
B., but they are not
infinitely malleable. One
should not be too readily
persuaded to side with Mrs.
B.’s position or with that
of her husband, her
children, or her boss. What
might seem at first blush
like a clear case of fate
conspiring against Mrs. B.
may turn out to be her
bringing things on herself,
e. g., by doing too much for
others, by not standing her
ground, and even by not
attending to her illnesses
in an optimal way. Might she
have chosen accomplices to
play out her cyclical
maladaptive pattern? Within
the ironic vision, nothing
should be taken at face
value or for granted.
With
respect to outcomes,
an ironic goal would be to
reduce the discrepancy
between the ideal (e.g.,
complete harmony between
Mrs. B. and her family; a
full recovery from her
illnesses; the attainment of
a higher degree) and what is
really possible by
recognizing the exaggerated
nature of the ideal and then
working to modify it. (To
modify one’s behavior to
approximate the ideal would
be a comic rather than
ironic goal). That is,
irony, like tragedy, is
characterized by a certain
degree of resignation, not
action.
Another
goal of irony is honest
self-perception and freedom
from illusion. For example,
Mrs. B. came to recognize
her own role in the family’s
issues and dynamics despite
her difficulty doing so; it
led to tears but also to
relief at its exposure in a
safe setting. The liability
of the ironic stance is that
its unremitting skepticism
and confrontation can verge
on hostility and lead to an
intensification of the
client’s self-criticism
(Andrews, 1989) and to
accusatory interpretations
(Wile, 1984).
In
general, each of these
angles of regard can
influence the conduct of the
case, allowing the therapy
to assume an integrative
character of the therapist’s
choosing according to the
mix of visions brought to
bear or his or her degree of
rootedness in a particular
theoretical/therapeutic
framework. The emphasis on
different visions should
also depend on the nature of
the case, and how receptive
the client is to working
within one or another
vision.
The
Visions of Reality and
Brief Psychodynamic
Therapy
I
conducted the case of Mrs.
B. within a brief
psychodynamic framework with
integrative elements, and
will offer here a general
account of how the visions
of reality are modified when
working within such a
framework. Some of the major
elements of brief
psychodynamic therapy (BPT)
include a time limit, a
focus formulated at the
start of therapy, more
active intervention and
dialogue than in long term
psychoanalytic therapy, and
goal setting. Although my
emphasis below is on
psychodynamic therapy, some
of the shift in visions
required undoubtedly apply
to other modes of brief
therapy as well. As the
practice of therapy in
general becomes briefer, it
is important to keep in mind
what the tradeoffs may be,
and one way of capturing
these is through the lens of
the visions of reality.
Brief
psychodynamic therapy
partakes of the romantic
vision by stressing a
tailor-made, dynamic
formulation of the client’s
problems: In doing so, it
prizes individuality and the
uniqueness of the client’s
quest. It values dreams,
fantasies, and spontaneity,
encouraging patients to
speak freely, to open up and
explore the unknown. As in
psychoanalysis, it expects
the process to be
conflict-ridden and painful
at times. On the other hand,
by emphasizing a rapid
formulation of the client’s
problems and the early
setting of a focus, the
open-endedness of the
romantic quest is curtailed.
The therapist, by selecting
interventions along the line
of the focus, and specifying
goals in advance,
deliberately narrows the
quest. Similarly, the
journey is shortened by
virtue of the time limit,
and the degree of
"redemption" or change
brought about is often
circumscribed. Nevertheless,
rapid termination-- going on
to face life on one’s
own--also lies in the spirit
of the romantic vision.
Brief
psychodynamic therapists
incorporate an ironic
posture insofar as
they strive to discern
hidden meanings, to uncover
the unacceptable wish or
feeling behind the defense.
Like psychoanalysts, they
adopt an attitude of
suspicion towards the
patient’s statements, taking
nothing for granted. They
challenge the patient’s
illusions, although not in
as thoroughgoing a way as in
psychoanalysis. The greater
activity and dialogic nature
of BPT, however, may tend to
obscure the recognition of
irony on the therapist’s
part. Also, since brief
dynamic therapy is not
open-ended and inherently
interminable, it
deliberately limits the
possibility of uncovering
multiple meanings and the
layers of personality
processes.
In this
connection, Kupers (1986)
has discussed the loss in
BPT of protracted
self-reflection. It is this
quality of psychoanalytic
therapy which Habermas
(1971) has referred to as
emancipatory. It is the
ability to get beyond
superficial and mystifying
appearances to the deeper
levels of personal or social
truth. The more that brief
therapy is narrowly
technical, adjustive, or
purely clinical, the more
conformist it becomes. To
the extent that BPT limits
self-reflection, the
possibility for unfettered
exploration leading to
radical criticism of self
and society is compromised.
The tragic
outlook is present in
BPT as it is in most forms
of psychoanalytic therapy.
Its theoretical base is
similar, as are some of its
modes of intervention.
Ironically, BPT is both more
tragic and more comic than
long-term psychoanalytic
therapy. It is more tragic
in that it often settles for
circumscribed gain at the
expense of fuller character
analysis and broader
structural change. It sets
limits on what is possible
by virtue of its brevity,
focus, and goal setting. The
practice of brief
psychodynamic therapy
recognizes the difficulty if
not impossibility of
transforming patients in the
miraculous and thorough way
they often hope for when
seeking treatment. It
accepts the limitations of
both inner and outer
resources for the task at
hand.
Brief
psychodynamic therapy is
also more comic in
outlook than traditional
psychoanalytic therapy. The
brief therapist approaches
therapy in a hopeful and
optimistic spirit. To
formulate a focus is to
regard client problems as
comprehensible, definable,
and predictable. The time
limit conveys a message to
clients that some problems
are, after all, resolvable
or ameliorable in a finite
time period, thereby
highlighting the potential
for human change and
improvement. The need for
separation, however, returns
the person to the tragic
vision at the end of
therapy. Nevertheless, even
at this point the therapist
conveys confidence that the
client can examine
separation fears, go through
with termination, and cope
with these fears.
The
therapist’s heightened
activity in BPT is also more
consonant with the comic and
romantic visions’ stress on
problem solving and action,
versus the more
contemplative and reflective
stance of the psychoanalytic
therapist within ironic and
tragic views. Insofar as
brief therapies incorporate
behaviorally based elements,
they take on even more of
the coloring of the comic
vision. To the extent that
specific goals are set and
aimed for in brief therapy,
it is more comic in thrust
than tragic.
For the
practitioner whose major
mode of practice is
long-term therapy, an
adjustment in vision of
reality is required to
conduct BPT. There is enough
similarity between long and
short- term modes, however,
that the shift is not a
totally radical one, but it
is a significant shift
nevertheless. Integrative
therapies each have their
own mix of visions of
reality as well. By
remaining aware of the
characteristics of each
vision, one may more readily
construct a therapy--short
or long term, integrative or
eclectic-- that contains the
mix of visions one is
striving to achieve.
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