Where is the Dialogue? A Social Constructionist View of Empirically Supported Treatments

Abstract

Since the publication of the list of empirically supported treatments by the American Psychological Association in 1995 a controversy has resulted between those who view positive psychotherapeutic outcome as resulting from the use of specific (listed) techniques and those who lean towards the so-called common or relationship factors rather than particular techniques as necessary for such outcomes. This paper examines the controversy and shows that both sides follow the same objectivisVempiricist and reductionist epistemology. In contrast, the paper adopts a social constructionist perspective and shows that the idea of therapeuticoutcome as linearly determined by either technical or common factors or a combination of these is a misleading oversimplification which fails to account for the dialogue which is the core of psychotherapy. Rather, positive outcome is viewed as mutually constructed in a unique dialogue which encompasses both common and technical factors. This takes the form of the conversational development of a new understanding or reframe of the problem followed by action which is deemed appropriate to the new understanding. This view is illustrated by practical examples.

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“…a social constructionist view of empirically supported treatments, David Fourie (2012) reflects on the polemic which manifested when the list of empirically supported treatments by the American Psychological Association in 1995 was made public. Fourie (2012) contends that the two opposing sides pursue a similar objectivist/empiricist and reductionist epistemology and, instead, adopts a social constructionist perspective. Using practical examples, he demonstrates that the notion of therapeutic outcome as linearly shaped by either technical or common (or a blend of these) factors amounts to deceptive oversimplification and does not succeed in explaining dialogue, which constitutes the heart of psychotherapy.…”