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Developing a dialogue: constructivist convergence in psychotherapy and beyond.

To explore the converging perspectives of two clinical psychologists who have long been active in constructivist theory, research and practice, a "next generation" colleague conducted a joint interview with them exploring themes of narrative, meaning making and social engagement as reflected in their evolving careers, while also adding her own perspectives. What follows faithfully captures the conversation that resulted, with only slight "narrative smoothing" and the addition of some implied references.

Caroline: Maybe I could start us off with a question. This is just a thought that came from me personally. I have to say that I am patently aware of the fact that I am conversing with two prominent figures in the field of psychology; figures whose names are in the textbooks, figures who have had a real influence on the field of psychology and its evolution. For me, I would be interested in hearing about each of your own perspectives regarding the evolution of the field in the last 30 or 40 years and how you construe your own role in it. Likewise, I would be interested in hearing each of your perspectives regarding the contributions of the other. For example, Bob, how has Don's work been meaningful for you? What do you view as Don's major contributions to the field? And Don, the same questions go for you about Bob.

Don: I like that, Caroline. The notion that we've been around for 40 years is a bit troublesome but other than that, I think...

Bob: [laughing] I have to say that I was doing the math myself to see if I could measure up to that but, sadly, I think that I came out with an affirmative answer, Don!

Don: [laughing] I think you're aging us!

Caroline: [laughing] Aging us? How about you reconstrue that ... into another narrative that's more meaningful and coherent?

Don: Why don't you start us off, Bob?

Bob: Well, I suppose in some ways we enter this dialogue as an insider and an outsider who moved inside to constructivism, or at least this is my construction of our respective paths. For my part, really from my earliest immersion in psychology as an undergraduate, I initially grafted onto a personal construct framework, in a George Kelly mode. That really became my native home base and although I've wandered far afield from it in many ways, I've always come back to it. I've continued to teach personal construct theory as a graduate seminar, one that you took some years ago, Caroline. So I suppose I could say that I feel natively constructivist, and I could talk a little about how I felt primed by life experiences for that a little later in our conversation.

To answer the other part of your question, Caroline, one of the reasons I was very eager to have Don in this dialogue is that he was one of the first and few "cognitive-behavioral" people who made any sense to me, in part because he never seemed, in my history of acquaintance with him, to overvalue rationality or empiricism to the exclusion of an emotional and relational dimension. This became very clear in his writing as he made a shift towards an attention to metaphor and storytelling and deeply incorporated a narrative perspective. But it was clear to me, even before that, in his vividly experiential style with clients. I found the theatrical quality of some of his interventions--his willingness to not simply talk about relationships with clients, but rather to enact and perform them, to be an authentic representative of the social world--all of that seemed much more alive to me. By engaging clients emotionally, vividly, he enabled them to reflect on the way in which they were constructing and maintaining relationships and patterns of symptomatology and distress, but not in a way that simply registered it in a triple column technique on paper or that rationally disputed certain cognitive distortions. Instead, he made therapy a living encounter between a therapist who was very much in the room and a client who was drawn deeper into the room. So, for me, that was my early and consistent impression of Don, and the reason I regard him as a fellow traveler.

Don: That's very gracious of you, Bob. It's fascinating that you start with George Kelly. I was an undergraduate at City College in New York City from 1958-1962. City College was a hotbed of Freudian psychodynamic psychotherapists. They had a visiting professor one year who would come and lecture. I became fascinated with this fellow and I sat at his knee listening. It turns out that his name was George Kelly!

Bob: I had no idea!

Don: I became enamored with his notion of a constructivist, story perspective and that not everything was drive reduction--that there was something else driving folks. I left there and went to the University of Illinois, which was a hotbed of behavioral psychology. At that point, just think about where we were: this was the onset of behavior therapy with Wolpe, Lazarus, Skinner, and so forth. In fact, as a kind of footnote to this, at that time, you could not submit an article to JABA (Journal of Applied Behavioral Analysis) that used the word cognition. All of cognitions apropos to Skinner were sort of mands, operants and coverants and, supposedly, thinking and accompanying emotions were subject to the same laws of learning as overt behavior. Now we've come to understand that the laws of learning don't even apply to overt behavior, let alone covert behavior. In the midst of all of that, they had a visiting professor who came and lectured--his name was Viktor Frankl. So I sat at his feet and absorbed his explanatory system of resiliency and storytelling, meaning-making and logotherapy. And at that time, the view of cognition shifted from a learning framework into an information-processing framework--that is, we were sort of like mini-computers. We were coding and decoding, we had schemas, and all of that. That became the language. In fact, I've written up this history and it's been published (Meichenbaum, 1977, 1992).

One of the things that emerged that was interesting was that I became steeped in clinical work, especially with people who had traumatic experiences and were diagnosed with PTSD. It turns out that PTSD is essentially a disorder of autobiographical memory. That is, something bad has to have had happened to you in the past (what DSM [Diagnostic and Statistical Manual of Mental Disorders] calls a Criterion A event) and not only that, but you have to remember that detail and tell a story either to yourself or to others about that event and its lingering impact and implications. So I became an exquisite listener to the stories people tell themselves and others--and I've written about the personal background that led me to this perspective (Meichenbaum, 1977). That immediately embeds you into this constructive narrative perspective. And you cannot embrace that perspective without reaching in and reading Bob's writings about the role that storytelling plays. For many of the clients that I was dealing with, it was complicated grief, because there were all kinds of losses accompanying that trauma. So I was enamored and learned a great deal from Bob's writing and his creative interventions on how to help people become unstuck from the hotspots and to transform their stories.

Historically, if we take your mandate of 40 years, Caroline, we can track the evolutionary perspective, and I think that the field of psychotherapy is stuck because it is atheoretical. It's about evidence-based concerns, but we don't know the mechanisms that lead to change. And I am very hopeful that a constructivist narrative perspective can really become the explanatory model of behavior change. I'll conclude by saying that we are each not only homo sapiens, but homo narrans. That means that we are all storytellers. I'll argue that the nature of the stories that people tell themselves and others is really critical. This is what I've highlighted in my recent book, Roadmaps to Resilience (Meichenbaum, 2013), and I've even given an algorithm of what you need to do to have chronic PTSD. But that's the evolution--you can start to see the telltale people, like Kelly and Frankl. I also spent some time with Jerome Bruner and crossed paths with Aaron Beck, Albert Ellis, and other people who were highlighting the cognitive perspective, though my take on cognitive behavior was always slightly different from theirs.

Bob: I appreciate the scope and depth of that substantial introduction, Don. I appreciate the generosity of it as well, with respect to your openness to learning from many people. And at least some of them are still alive, I'm happy to report! It's a delight, in that way, to extend the conversation.

PERSONAL ACCOUNTS THAT ILLUSTRATE A CONSTRUCTIVE NARRATIVE PERSPECTIVE

Bob: So let me also shift to a personal level. It strikes me that, although I didn't realize it at the time, or for many years subsequently, I really represented a kind of case study of that trauma-based disruption of narrative that you allude to as having been centrally important in the way you think about narrative. Certainly I found myself attempting to put together a story that accommodated some autobiographical episodes that were incoherent or didn't easily fit within the plot or thematic structure of my life story. So if I were to trace back to what was happening for me about the time you were encountering Kelly and Frankl, what I was encountering was a father who died by suicide during a period of deep depression just before my 12 th birthday. One cold January morning in Ohio, my brother and I woke up to our mother's panicked entry to our bedroom saying, "Boys, boys, I can't wake your father!" As we got out of bed in our footed pajamas and nervously went to the threshold of their bedroom and peered in around the doorjamb, I saw her reach down and try to awaken my dad under this turquoise bedspread that covered him, his face turned away from us. And he just kind of flopped onto his back as she tugged at his shoulder. At that point, she let out a scream that basically ended childhood for us and launched us into a very different place. The ways that we were able, each of the three of us children--me being the oldest, my brother Greg (there beside me), and our little sister (still sleeping in her room)--we were all launched into an effort to somehow make sense of an utterly senseless event that fractured the foundation of the world we lived in.

Looking back, I managed in the ways I could as a teenager, focusing on work and school as a more stable alternative to a family context in crisis. But ultimately, as I moved into college and encountered my first substantial immersion in psychology in a class taught by Seth Krieger (a student of Franz Epting, himself a student of Kelly's), I began to find in George Kelly's work a frame that could help me begin to hold some of the terror, complexity, and strangeness of the world to which Dad's drug overdose had introduced us. I was especially drawn to what Kelly called "dimensions of transition": concepts like anxiety understood as confronting a world that you simply couldn't scaffold, anticipate, place meanings upon; the idea of threat, of finding yourself now in a world in which you were nothing like you thought you ought to be or would be. These concepts made a visceral kind of sense to me. So my own attempts at meaning making really benefited from having a Kellian vocabulary to wrap around them. I found myself then working in suicide intervention centers and beginning to do research from a personal construct standpoint on people's attitudes towards death (Neimeyer, 2000). Eventually, that moved into a focus upon trauma and bereavement (Neimeyer, 2009). In this way, I suppose you could say that, across the course of a career, I came home to myself, but always with an investment in the practice of therapy, the study of its processes, and the role of meaning-making in the development and breakdown of life narratives.

Don: That's quite a story, and the way in which you've been able to transform your life given that developmental tragedy is indeed impressive. I spend a lot of time now working with returning soldiers from Iraq and Afghanistan and deal a lot with the aftermath of natural and other disasters. For example, tomorrow I am going to Biloxi, Mississippi, to consult with the VA [U.S. Department of Veterans Affairs]. The following Wednesday, I am going to Atlantic City to talk to the mental health community dealing with victims of Hurricane Sandy. I sort of go from disaster to disaster. When you hear stories such as your own, Bob, or of the returning soldiers, or the victims of natural disasters, the one thing to keep in mind, which is really impressive, is if you look at the work of George Bonanno, Anne Masten or other people I've written about on the Melissa Institute Website (see www.melissainstitute.org), 75% in the aftermath of these kinds of tragedies evidence an impact but then go on to evidence resilience, if not posttraumatic growth (Meichenbaum, 2013). And 25% of people show some kind of persistent PTSD. So what I find interesting is that the people who are in the 75% group--and I put you there, Bob--find a framework to do meaning making. And that which was credible for you was the Kellian framework. But, for instance, in the aftermath of trauma--like the Newtown school shooting or in the aftermath Hurricane Katrina, or others--in all of these instances, the major way that people cope with trauma is by using some form of spirituality (See Meichenbaum, n.d.). So one of the things that becomes interesting from my perspective as a constructivist isn't that there was anything special about the Kellian framework or anything special about the spiritual framework that you have, but that you have some therapeutic benefit to hang this event on and to find meaning in it. So, as a constructivist, I am really fascinated with the way people fabricate meaning in order to bolster their resilience. For you, Bob, given that you were saturated in psychology and saw that as a professional direction, a Kellian perspective may be appropriate. But when I present workshops on PTSD, I show a video called "Where was God on 9/11?" for people who lost loved ones there. And you can see the way in which they reach out to some kind of spiritual meaning or some sense of tradition. And that becomes the coping mechanism. So, I'm interested in what are the communalities of the psychological mechanisms that put people in the 75% group versus the 25% group.

What was it about the Kellian framework that you found particularly therapeutic? So, Bob, imagine that you are my client for a moment.

Bob: Oh, I love the idea! Why didn't you think of this years ago?

Don: How did finding that meaning system in any way help you with that remarkably distressing event that happened?

Bob: The answer would begin with recognizing that we do not search for what we haven't lost. Had my existing spiritual framework of Roman Catholicism held in the wake of that tsunami of distress, I probably would never have been a constructivist. I might be a priest today instead! But, in fact, my spiritual framework ultimately collapsed under the weight of dad's death. My immersion in the Latin mass, the recent conversion to English--none of that had gelled into a mature spirituality for this 12-year-old kid. And so I relinquished that. I spent a couple of years exploring a more fundamental Christian perspective and then abandoned that as too concrete, too historically situated to have specific relevance to my family's psychosocial struggles in the second half of the 20th century. And after a period of reading Camus, Sartre and other existentialists, I was pretty thoroughly secular by the time I encountered Kelly. What Kelly offered, then, was something on the other side of nothingness. There was a "somethingness" about his theory. There were concepts that held mirrors to my soul, in a secular, psychological way, and helped me understand some of what I and others had experienced and suffered, in the sense of Frankl's statement that those who have a meaning for suffering--a "why" for what has happened--can survive nearly any "how." I began to construct that meaning in Kellian terms. Kelly offered language that had to do with sense-making while also accommodating emotions as intrinsically meaningful signals of the state of our efforts to negotiate reality, to anticipate and interact with it, especially the reality of the social world. That made a native sense to me and it provided me with an initial scaffold on which, ultimately, a larger constructivist edifice began to rise.

Don: One of the things I train clinicians to do is to be exquisite listeners to their client's language. Let's reflect on what you've just said. What it is about the Kelly framework that you found particularly valuable? You have bathed your social discourse ... I was taking notes as you spoke--you can't take the clinician out of me ...

Bob: [laughing] I wouldn't want to try!

Don: You use words like "accommodate," "meaning-making," that you "anticipate." You bathed your storytelling in what was comforting. There are a lot of what I call "metacognitive-active-transitive" verbs. In your story now, you have a lot of hopeful, "change-talk" words. You gave up one thing and have now found another. So you gave up your Catholicism, and the evangelical kind of perspective, and you were on a search. And your poetry comes out. You have a "mirror on your soul." That's poetry! If I were the clinician, I would be interested to pluck that metaphor. So I'd go, "Bob, mirror on your soul? Is that mirror still there now?" ... You know, that kind of conversation.

So I think that we could develop a metric--a type of coding system--an analysis of what are the key elements of peoples' speech that you have to include in order to not get stuck. As a teenager, you had the potential of going the other route, of being in that 25% group ... So, as you tell your story, you just naturally embed within it these metacognitive-active-transitive verbs. Not only that, but you embed, also, "re" verbs--you know, like "I re-gain composure," "I re-connected," etc. So I think that the next step for a constructivist narrative perspective is to develop a methodology--where you could actually do content analysis--and see how people change stories. I could have done this interview with someone who was a born again Christian and he or she would have said how they found their faith, then re-arranged their priorities, they found meaning in the divine, sense-making ... Bob, does this make sense to you?

Bob: It makes compelling sense to me. One thing I love about it is that, as a coding system, it focuses on the verbs rather than the nouns. It looks not at categories of meaning made, something we've actually done in our own research (Gillies, Neimeyer, & Milman, 2014), but it instead looks at how those meanings are transformed. I think that verbs get too little look in psychotherapy generally. The field in general tends to have a classificatory approach to diagnosis, looking at boxing people in, but you're really opening the boxes with your attention how they introduce change--the language they use to structure that, or the absence of such language--language of foreclosure, language of certainty, language of closing down.

Don: I was just using you as a case study, an N of 1, here ...

Bob: Please, feel free.

Don: You have the courage to poignantly not only share it here, but in writing as well, about this particular loss. If you read Tom Joiner's (2005) book, he starts off in the same way. I do a workshop on suicidality. In fact, if you go to the Melissa Institute (see www.melissainstitute.org) I have a handout there, where I wrote out what it is that you have to tell yourself in order to die by suicide. What were the thinking processes that your Dad, or whoever engages in this type of behavior, must engage in to get to that point, such as the power of the word "only," or the degree to which you engage in black or white thinking. I think the literature gives you a pretty good script of exactly what you need to do to get to that focal point (Meichenbaum, 2006a, 2006b, 2013; Meichenbaum & Fong, 1993). Similarly, I could do a script on what you need to do to get PTSD. If there is any merit to these scripts, it would have a lot of implications. How do you get people unstuck from that script? It would be interesting to take a variety of conditions--PTSD, suicidality, and more--and write out what the constructive narrative perspective proposes as a sequence of things that you have to engage in as a sort of mood induction.

Bob: Caroline, why don't we invite your reactions before I jump right back in. I'm eager to do so, but want to make room for you.

Caroline: I've actually been quite intrigued by this whole process. We've just had a conversation in which Bob talked about a profound and painful experience--about a trauma that profoundly impacted the course of his life. And we connected that experience to Don's work on resilience and, interestingly, Bob's path to resiliency is this very narrative, constructivist, meaning-making approach that now guides his approach to psychology and psychotherapy. I wonder, Bob, whether you're the first person to give credit to constructivism for doing that--for creating a path to resiliency that bolstered both you and the theory itself. I'm just sort of struck by the beauty of what has unfolded here in our discussion. There is something reflexive about what just transpired: constructivism was used to transform Bob and, in the process--because of Bob's subsequent accomplishments in the field--constructivism, too, was transformed.

Don: [to Caroline] When we analyze this transcript, focus on how Bob described this incident. If you analyzed that segment, then you could see how I was able to pluck out and attend to specific things that make that story a resilient story. How his mother's scream ended his childhood. Or how he then searched for meaning and came to George Kelly. If you type out that 3 minute thing that he said--that is the story of resilience, how he gets himself into the 75% group.

Bob: I want to underscore the 75%, because we're not talking about an exception to the rule, in my case; we're talking about the rule. And it's the commonplace audacity of people in all walks of life, drawing on all kinds of life narratives to somehow surmount tragedy We do it frequently, not merely once in a lifetime but often multiple times. Ultimately, we recognize that every person, every place, every project, every possession we love, we will one day lose. Our lives are marinated in loss. Most of the time, we manage to swim through the soup of that pretty well and come up on the other side, as our research also documents (Currier, Holland, & Neimeyer, 2012; Neimeyer & Sands, 2011). I think that Don's genius in recognizing that I'm just part of the majority is very compatible with Kelly's view of reflexivity--that we need to construct a psychology that is adequate to who we are as psychologists, as theorists, as human beings who are attempting to make sense of our own behavior and that of other people. This is one of the draws, magnetically, for me, to constructivist work. That is, the constructivist mirror of our souls, to go back to that image, is one that I think is well-polished--it lets us see ourselves with some level of clarity. We don't feel shrunk or distorted by the reflection; if anything, it ennobles us--even in our most despairing times--to recognize that we're still passionately pursuing a way of being that makes sense, that has coherence, that connects with others, and with a purposeful future ... even in our anguish.

Don: One of the things to keep in mind is that you can be both resilient and still have post trauma stress. The sense of loss and mourning--the loss of your childhood and all the other things--can coexist with your being a major contributor and using your own personal experience to help others. It isn't as if it's an "either or" kind of process.

My major concern in all of this is: How do you get those who are embracing a constructivist perspective to have an impact on the rest of the field, so that we don't become the Fox News of psychology, only talking to each other, people who believe in the same things. From my perspective--especially if I were starting my career like Caroline and wanted to have an impact--it would be really interesting to develop some line of research that demonstrates that the constructivist perspective has major implications. That it has predictive power to tell--in the aftermath of Newtown or Hurricane Sandy--who is going to fall in the 75% versus the 25%. And that you would get story telling from these people over the course of the recovery process. And they would be able to count the number of verbs, the number of "re" verbs, the ability to find meaning, the degree to which you can nurture social supports. When I lecture on trauma/spirituality/recovery, one thing I say is that believing in a higher power is like outsourcing social support. You have this higher power you can read into. If you ask people what it is about spirituality that is particularly helpful from a narrative perspective, you can see that the way in which you embrace Kelly, they embrace these others. The metaphors they use aren't that much different from the ones that you use. You get a figure of speech in your head and it triggers another, and you stay with that metaphor. Every one of these has one thing in common: that it is a journey. They don't know where it's going to lead but from that landmark event--when your mother screamed--that put you on a different trajectory than the one you were on beforehand. And you are negotiating that trajectory. There's an implicit sense of movement to the storytelling. There is not only the content of the verbs and the number of "re" verbs, but the degree to which an independent judge could read this and see the commitment to a journey that is hopeful. The other thematic thing is meaning-making. You, Bob, have been able to transform this into a personal journey of a career. You translated this tragedy into being able to become the go-to man in grief therapy.

When obtaining multiple stories of people who have been victimized, such as in the recent Boston marathon bombing--how are they going to recover? The key question is: If you had the opportunity to just be an observer of their storytelling, what would that look like? I've often characterized myself as a cognitive ethologist. As an observer, imagine that you're a cognitive ethologist studying how peoples' narrative changes over the course of time. If we could develop a metric that people could use, then constructivists would have a real impact on the rest of the field.

Bob: We've done a fair amount of research on some of these processes, at a certain level, and yet there's a gap, Don, that I think you can help fill. What we've established through studies of bereaved young persons, people who experienced the violent death of a loved one (homicide survivors), those who are bereaved in later life (loss of a spouse), parents who have lost children, a whole range of losses, is that those who are unable to construct a meaning of the experience tend to suffer much greater risk of complicated grief outcomes; prolonged, intense yearning; destruction of their lives--often across a period of many years (Neimeyer, 2011). We also know, from some of our longitudinal studies that those who are able to find meaning in the event--to be able to make sense of it, very often, as you say, in spiritual terms--tend to do better in the long run (Coleman & Neimeyer, 2010; Holland, Currier, Coleman, & Neimeyer, 2010). As much as four full years later, they experience a heightened state of well-being, confidence, hopefulness, joy, and so on, than those who do not achieve that kind of meaning-making in the earlier aftermath of loss.

With respect to spirituality specifically, we do find evidence that people who are able somehow to wrap their hearts and minds around the loss in spiritual terms--to see it as God's will, to have hope for reunion--are comforted by this and suffer less complication and anguish in their grieving, and more psychological growth (Burke & Neimeyer, 2011; Currier, Malott, Martinez, Sandy, & Neimeyer, 2012). But they sometimes find that their religiosity becomes more a source of complication than comfort. We have found that about 25% of spiritually-leaning bereaved people faced with more severe crises, like the murder of a loved one, tend to experience not merely complicated grief, but also what we are referring to as complicated spiritual grief (Burke, Neimeyer, McDevitt-Murphy, Ippolito, & Roberts, 2011). When we look at the data longitudinally, these survivors' earlier experience of complicated grief--this intense, separation-distress with reference to their lost loved one--begins to generalize into a kind of separation-distress in relation to God. They begin to feel that God either was not on duty, didn't care, was powerless to avert the tragedy, or--in a more sinister way--is inflicting the death of the loved one on them as a kind of punishment for their own lack of faith or wrongdoing (Burke et al., 2011; Burke et al., 2014 b; Neimeyer & Burke, 2011).

Interestingly, what happens is that these religiously-inclined people almost never doubt the existence of God, but rather they re-narrate their relationship with God as a neglectful or abusive parent. They may also experience a second level of disruption, in addition to this vertical dimension with God, as the horizontal dimension of their relationship with their faith community also may erode. So we've developed some measures to look at things like the integration of stressful life experiences, the attribution of meaning to them, sense-making, finding a new, practical footing in the world (Holland et al., 2010). We've also developed a measure to look at complicated spiritual grief in the terms we're speaking of here--the erosion of a secure relationship with God, as well as disruption of religious practice and community (Burke et al., 2014a). All of that converges with what we're speaking about, but it leaves the critical clinical processes, which could be revealed under this lens of cognitive ethology, a mystery. That is, we still need that close analysis of language; we still need to listen with a clinician's ear to the evolving story of our clients in session, which we may inflect in one direction or another to render more hopefulness in the account. That's what we lack, and that's what I think you're pointing us to: the next step in our research and our clinical horizons.

Don: That's definitely quite fascinating. In my Roadmaps to Resilience book, I highlight a lot of the work of Ken Pargament and his colleagues because they've highlighted both the positive and negative aspects of spiritual involvement in fostering resilience or not. Insofar as the individual who has had the losses that you describe believes that God has abandoned them or punished them, their anger interferes with the healing process. You could actually look at those individuals who still turn to a higher power for some meaning making, but come to an interpretation that would exacerbate their stress. In fact, one of the things that becomes evident is that after a certain point in time, it is mostly likely therapeutic to no longer continue to search for meaning. There comes a point when whatever happened with your dad, or other kinds of losses, does not have an explanation. Therefore, how do you come to terms with this? For instance, an anecdote that I cited in the Roadmaps to Resilience book comes from Elie Wiesel. What he reports is that in the concentration camps the Jewish inmates held a trial. They wanted to know if God was guilty--in the sense that He could have prevented this or He could have done things along the way. So they hold this trial and the jury decides that God is guilty. He's just guilty. And after the trial they all go back and pray. So the fact that they found Him guilty in no way precludes that He would still be a beneficial belief system for them to have. So there are these beautiful incompatibilities that occur.

With regard to cognitive ethology, you could go to the literature on religious coping and spirituality and see who falls into the 25% group. The thing that is interesting is that people can be resilient interpersonally, or in other kinds of activities, but strictly have that compartment of when they give up their faith. You did not find Catholicism as being supportive in your key personal transition and you gave up others along the way. It's like the Life of Pi, but here it's the Life of Robert. Have you seen that movie?

Bob: Yes, I've seen at least some good portions of it.

Don: It's a story of searching for meaning.

Bob: In pointing to the casualties to religious faith that can accumulate on this journey, it's also useful to remember that it's those very fracture points in the foundation of our belief that often permit new growth to occur, or reorganization to happen. That's how beliefs of any kind tend to be tried and tested and, when found wanting, are more commonly reconstructed than they are relinquished. I think that's in some way the source of spiritual maturation or development ... or one might say developing more philosophical gravitas. I don't want to refer only to spirituality, especially in that kind of Judeo-Christian frame that we have been implicitly assuming. There are many other forms of spiritually, in a Buddhist, Hindu, Taoist or Islamic frame, a New Age kind of relationship to the divine, or, of a secular sort of philosophy that can equally be tested and grown in response to these loses.

Don: Think about this at the level of the therapist. The fundamental question of therapy, from my perspective, is, "How do you get the client to re-narrate? How do you get them to re-story? How do you get them to re-author their lives?" It's not that they're going to develop a better story that's delusional in some sense, but they actually develop the accompanying coping skills that lead to corrective experiences. They take data from those experiences to confirm this belief. It's kind of an evolving journey perspective. You sort of get disconfirmations or confirmations--and that's where I thought George Kelly fit in really well. In his personal construct model, you can think of the polar opposites. In his fixed-role therapy, he would get people to act as if they were different, which would lead to corrective experiences. Then Kelly would play this Colombo-like character and with puzzlement say, "What are you telling me? Are you saying that you are not this nerd, nebbish, withdrawn person?" That kind of evidential model ... in some sense, you're turning the client into becoming their own detective, their own therapist.

One of my favorite questions to ask a client is: "Let me ask you something a bit different or unusual. Bob, do you ever find yourself, in your day-to-day experiences, asking yourself the kind of questions that we ask each other right here in this dialogue? Do you ever ask yourself, I wonder how many verbs I just used in telling my story? Do you ever start to reflect on the number of 're' verbs you re-narrate?" And your verbs are terrific! They "mirror" the soul; they "swim" in things. You're a walking poet!

That is what constructive narrative is all about. And there are dozens of other strategies that therapists can use to get clients to re-narrate, re-author, re-story, re-gain, re-connect....

Bob: I love that. That's the font of clinical creativity--when you move to that level of interactive exactness in being able to offer a strategic view in which people see themselves differently.

We often think of narrative in a representational way--it's a story about something, a description, an explanation. But in connecting the idea, as you have, with Kelly's fixed-role therapy--where he is having clients go out and do the world differently, to try on a different set of constructs and observe their relational and identity implications--what we're reminded of is that narratives are essentially scripts. They tell us how to be, who to be, who to be with and how. One of the tragedies of a more thinly-textured cognitive-behavioral view is that it privatizes experience; it makes it something that is almost purely internal and largely intellectual, with a few arrows going back and forth to another box that contains vaguely-described affects or symptomatology (usually conveyed in psychiatric terms). What we need to do is to externalize constructs, to see them as ways of being with others. And our narratives both capture and inform how we engage the social world.

That step that you, Don, were inviting me to take--to start paying attention to the verbs I use in real social context, in a real world--is exactly where we need to be going. It's bringing the world to bear on our psychotherapeutic experience.

Don: It has wide implications. I'll give you two examples. I was invited to write material for individuals who do peace negations in the Middle East and other settings. I wrote a chapter of what the world would be like if political leaders actually had a constructive narrative perspective as part of their vocabulary (Meichenbaum, 2011). Just imagine if the two of us, Bob, were there when Bush and Cheney were deciding to invade Iraq. Imagine how we would do the therapy to get them to look at their decision-making. I wrote up the twelve, "dirty dozen" errors that lead political leaders, from the narrative perspective, to make war-engendering decisions. I included a session with the president. As the therapist, I say "Mr. President, I notice something and I wondered if you notice it, too?"

Not only at the level of clinicians, but if you think about it in much broader terms, how do people make decisions to blow up other people? What are the steps of making a terrorist? Of going to war? They are all these kinds of narratives--to be a member of a political party or religious group who evidences little or no compassion for the suffering of others and who treats them as "objects." I think that the constructive narrative perspective is much broader than just the clinical domain. All of these decisions are based on stories, fallible stories, as in Chamberlin's narrative of Hitler's intentions ... they use metaphors from the past. You may find the chapter interesting because it goes through all of these historical accounts where politicians made the wrong decision. The Bay of Pigs, the invasion of Iraq, the escalation, the Surge--all of these were fallible people making incorrect decisions based on the stories they were telling themselves and others.

So in my 40 years as a therapist, Caroline, I've now come to the point of becoming grandiose to think that this has a much broader perspective than just the field of psychotherapy.

STEPS TO A CONSTRUCTIVIST PSYCHOLOGY

Caroline: Well, Don, what you just said--about constructivism potentially being a much broader perspective beyond the field of psychotherapy--inspires me quite profoundly, and it segues very nicely to a question that I have been eager to ask: Could there be a meaning-making revolution in psychology? With regard to my constructivist/ narrative inclinations, a colleague recently referred to me as a member of the "unsung minority." Is there any chance that we might become a more dominant voice someday? I'm not sure whether my own answer would be optimistic or pessimistic. I'm not sure whether I believe that such a paradigm shift will unfold in psychology.

When looking at the Melissa Institute website I was--probably for the first time in a long while--a little bit more inspired. I was inspired because, Don, it seems that you are using the constructivist approach in research that is now being used to advocate for social change and public policy. If I were to think of an avenue towards such a revolution, that would be one pathway.

Don: One quick comment, Caroline: Get rid of the word "revolution."

Caroline: Why?

Don: There are no revolutions in psychology or in science. It's "evolution." There are many people: back from Wundt to Breuer to Freud to Korzybski to Kelly to McAdams. I did the history of the constructive narrative perspective (Meichenbaum, 2003) and Wilhelm Wundt was a constructivist, so we're catching up with the past. It's cycles. That's the way paradigm shifts occur. You know, you get these guys--like Hayes and others who are into acceptance theory--and it's the "third revolution." There are no revolutions! But I think your point is well taken.

Caroline: Okay, so if we were to see a meaning-making evolution, what would we need to be doing well in order to see such an evolution transpire?

Bob: I think that Don's point that there is a kind of persuasive rhetoric in the social sciences, founded on an empiricist model ... and we, no less than others, can play that game well, and, indeed, be informed by it--sometimes even to the point of being surprised by our own results! So there is a research paradigm that is implied in what Don is talking about. It's only partially realized in current constructivist research and it could be greatly deepened by moving to that speaking-turn-by-speaking-turn analysis that he is talking about. Essentially, a kind of pragmatic discourse analysis is being advocated and is entirely feasible to pursue.

However, just to speak on the other side of this for a moment, I think all of us could also look at the current state of the world and the field, and we might admit that the field is not very propitious for the kind of evolution that we're talking about. We have indebted ourselves to a psychiatric system of classificatory diagnoses; reduced our imaginings to something far less than a grand narrative theory: to looking at clusters of symptomatology or the biological basis that presumably underpins them. All of that tilts the field away from this human, relational, discursive, rhetorical shift that we're endorsing and exploring. And ironically, it may be that these clinical insights will in some way be best cultivated outside the clinical arena. It may be in the analysis of politics, maybe in leadership development in the business world, maybe in coaching people in various forms of not only non-violent communication [laughing], but also in non-violent cognition. Maybe we need to get outside of the psychotherapy field in order to realize this possibility.

Don: I'll take the other side of the coin. There are two major things happening in the field of psychopathology and psychotherapy that speak well for a constructive perspective. First, there is increasing data that the so-called evidence-based therapies--the actual, specific treatments--count for a very small proportion of the variance of outcome. It has to do all with therapeutic alliance, and the characteristics of the personality of the therapist and how he or she behaves therein. If that kind of argument is upheld, then, once again, they're now looking for what it is that characterizes these therapists in terms of the core skills. Once you enumerate that, it becomes apparent that expert therapists are really good storytellers, are really good at getting people to alter their stories, to engage in corrective experiences. When we start to look at the content analysis--as Miller, Duncan, Lambert and those guys are doing--you're going to find that they're going to eventually embrace a constructive narrative perspective. That's the one side of this.

The other side is that the NIMH [U.S. National Institute of Mental Health] is now questioning the DSM-5. That's going to open up a whole new search for what I call transdiagnostic communalities across psychopathology, and a whole new classification system. If you look at people across a whole variety of disorders--whether it's psychotic, bipolar, schizophrenia, anxiety, depression, and so forth--I think the communality that is going to emerge is also a constructive narrative perspective. I'm really quite hopeful for both of those efforts. For people who have committed their lives to evidence-based therapies, and people are shouting at them to reconsider how important the specific interventions contribute to change versus the role of the therapeutic alliance ... well, it's quite a challenge!

Next Saturday, I am going to have dinner with Aaron Beck. I have the highest regard for him, just as a human being. He has developed cognitive therapy and deserves every credit. There is now a review in the clinical psych literature that shows that cognitive therapy for depression is no better than bona fide comparisons (Baardseth et al., 2013). I don't know how to break the news to him. I'm going to tell him that I'm in a quandary because I train clinicians. The key question is, do I advocate for one specific way? I just came back from San Antonio where I was training people who do Internet therapy with soldiers from all over the world. The key question is what was I going to advocate? Do I go for the exposure-based cognitive processing that the VA embraced? Or do I highlight that there are multiple other models, other kinds of interventions? So I think that as the field is coming to recognize these limitations, it opens it up to a new paradigm. That is, you needed some questioning of the already-existing paradigms, and when they don't work, when you find out that the laws of learning don't apply to overt behavior let alone covert behavior, when you find out that information-processing is a metaphor that has limitations, that people use metaphors and other kinds of things that guide their scripts, then it opens it up.

So I'm much more optimistic. I wish I was as young as you, Caroline, so I could see what the next 40 years would look like and where the constructive narrative will fit in.

CAN CONSTRUCTIVISM EVOLVE BEYOND PSYCHOLOGY?

Bob: Maybe that's a good question to turn to. It's certainly one that you and I can engage, but maybe Caroline also has a perspective on that from her own generational standpoint, as to what this field is evolving toward.

Caroline: Well, to be honest, I vacillate between two feelings. Sometimes I experience optimism regarding all the prospects we've just discussed--that psychology may evolve to new ways of thinking about therapy, diagnosis, and psychopathology and that constructivism may play a strong role in leading us there. Sometimes I feel pessimistic when thinking about all the obstacles that we face as a group or as a non-dominant voice.

Just to think of another direction for constructivism, an area to which I would like to personally contribute: How can I make use of the constructivist and narrative approaches as an instructor? As an educator? How do I bring that into my life and the work that I do? For me, I can answer that question by bringing more of it into the teaching of psychology. I recently conducted a study that adapted Kelly's fixed-role enactment into a class assignment. I should say that this was actually inspired by your work, Bob. I remember that while I was in graduate school you were doing that study, the fishbowl ...

Bob: Yes, "Fixed-Role in a Fishbowl," I think we called it (Neimeyer et al., 2003).

Caroline: I remember you doing that with graduate students to teach them about Kelly's fixed-role enactment and how to employ that in a clinical setting. I wanted to introduce something to undergraduates rooted in Kelly. In doing so, I was hoping to assist students in conceptualizing personality more broadly, to consider personality as a process that can evolve over time. I wanted them to use role enactment to entertain new possibilities and-- borrowing from Don's language--I wanted them to experience "re"-verbs ... to see how we have the power and the freedom to re-evaluate ourselves, to re-construct our lives and our views of ourselves. This study suggested that students find this enactment to be profoundly meaningful (Stanley, Glendening, Hatfield, & Boldoser, 2012).

So I would like to see continued growth in using these techniques in the classrooms--using constructivism to promote profoundly meaningful experiences for students regarding personal change. So I hope that answers the question a bit, about another area in which I would like to see growth.

Bob: The whole area of pedagogy is a fascinating domain of application and one in which we have been long engaged. As recently as three weeks ago I was doing that same exercise, having a group of 10 graduate students in counseling and clinical psychology collaborate to analyze the character sketch written by one person of himself and then, basically, to deconstruct it and reconstruct it along very different lines. We put together a noble character whose name was Samson Knight. I think the first line of the enactment sketch was something like, "Like the rest of us, Samson carries a lot of baggage, but he carries it better than most of us." We went on to construct a two-page identity to inhabit for a two-week period. It was a life-changing experience for him and a great experience for the collaborative witnesses to the change.

What I started doing, in keeping with these ideas of narratives as scripts--whether in that traditional Kellian sense transposed into the classroom or going out into the broader world analyzing struggles in the way that Don is doing--is that I've started partnering with a theatrical group called Playback Memphis. This is a group of professional and amateur improvisational actors who perform stories spontaneously told by members of communities. It's community-wide in the city of Memphis where people--Black, White, Hispanic, Asian, of all ethnicities and social stations--convene in a theater to tell stories about their lives that may be suggestive, whimsical, and brief, or deep, tragic, or extended, and to have these then performed in the moment spontaneously by actors who step forward and dramatize the affect, dramatize the internal sense of conflict, uncertainty, ambiguity, division. Typically they play out the more challenging narratives in a way that is hopeful or redemptive. For example, we've done this when an entire auditorium was filled with homicide survivors, and the stories being performed--prompted by stories told from the floor, in the theater, by survivors of the loved one's murder--are then performed immediately, with no rehearsal or script by the actors, in a way that captures, validates, honors the story of love--not the story of the traumatic loss, but the enduring story of love that goes beyond the loss (Murphy & Neimeyer, 2014). The amount of transformation that happens within and between people is palpable. So one of the ways in which I'd like to see us carry forward the work with narrative is in this very experiential way.

In Spanish we'd use the word vivencial--that is, a much more embodied, active, relational, public way of working. For example, we have a grant-supported research study entitled Performing the Peace we're now launching that looks at the impact of this kind of community performance of narratives as a transformative process in improving relations with police in violence-saturated communities. Many other expressive arts approaches--visual, musical, dance and movement oriented as well as involving creative writing--can greatly expand the range of our meaning making practices in therapy (Neimeyer, 2012; Thompson & Neimeyer, 2014).

Don: What you are describing is what Mandela and others did in South Africa. It's what happened when they took victims and perpetrators and, rather than seek revenge, they found the mode of storytelling. I've written about a variety of interventions that they use (Meichenbaum, 2009). For example, in the work of Agger and Jensen and so forth, they're working with victims of trauma from South America and they use what is called the testimony procedure, which is basically storytelling. In fact, I consulted to a mental health community who work with 400,000 torture victims who live in the United States. And it turns out that that kind of narrative approach really works well with people from South America and others. But when dealing with victims of South East Asia (the Cambodians, and so forth) then that narrative backfires and their focus is much more on problem solving. So, you have to do this in a culturally sensitive way. I've worked with native populations where storytelling is really critical. It would be very interesting to get multiple examples of how storytelling has been used as part of the healing process. To document--from torture victims, to homicide survivors--their narratives. There are many examples along those lines.

One quick thing to Caroline--because I listened to your language very carefully: Instead of seeing constructivism as facing "obstacles," you want to see them as "challenges." If only you see these as challenges you are less likely to become depressed. In your language you have "obstacles," you view people as "unaccepting" ...

Caroline: I see. So seeing it as "challenges" will elicit my optimism, but seeing it as "obstacles" will bring out my pessimism.

Don: What you need to have is a delusional system. This is what makes an effective researcher: Think that you have discovered a "truth" and it is your job to come up with persuasive evidence. So these are not obstacles. These are opportunities for you to enlighten other people.

Caroline: I like it!

Don: You can't talk to me without some aspect of your language being analyzed. So, Caroline, you have some things that you can take away from our discussion: You're not going to use the word revolution, you're going to use the word evolution, and ...

Caroline: ... yes, I'll say challenges and opportunities, rather than obstacles. Very good, practical advice!

Don: Well, just keep that it mind ...

Bob: ... especially as you launch a new phase of your career! Don, in closing let me just also observe that earlier you talked about the importance of master therapists being good storytellers, but I'd like to add--with you as a prime example--that a master therapist is also an excellent editor!

SUMMARY AND CONCLUSIONS: THE FUTURE OF CONSTRUCTIVISM

The foregoing transcript depicts an unscripted conversation among two prominent figures in the field of constructivist psychology and me (Caroline), a "next generation" constructivist psychologist. Emerging first in our dialogue was a discussion regarding the evolution of the constructivist perspective. In the process, these leaders reflected on their personal trajectories within constructivist psychology and the thinkers who influenced their work. What followed--as Bob shared the details of a personal life tragedy and as Don elaborated upon it--was an analysis of resilience using a constructive narrative perspective. After experiencing this first-hand account of the practical applications of constructivism, our dialogue focused on the future of the field. Specifically, we considered how a constructivist perspective could further the evolution of psychology and whether constructivism had implications beyond psychotherapy.

As a "next generation-er," this interview inspired a sense of optimism regarding the future of constructivism. This optimism may be explained, in part, by a compelling realization that constructivism is strongly rooted in psychology. Constructivist ideas are not new; constructivist thinking is apparent in early psychological theories (i.e., Wundt) and such thinking has persisted over time in the work of influential figures (i.e., Frankl, Kelly). In this sense, constructivism has a longstanding presence or a unique "narrative" within the history of psychology. Likewise, as exemplified by Bob's inclusion of Gorge Kelly's work into the field of grief, constructivist ideas have expanded and evolved over time. Further, as illustrated in Don's constructive narrative approach--a perspective that draws from cognitive, behavioral, and meaning-making frameworks--constructivist theories can and do evolve in ways that are not incompatible with traditional psychology. In essence, the next generation of constructivists may be well-equipped to advance constructivist ideas in quite the same way as before: through integration with other psychological theories and frameworks.

It must be noted, however, that the potential for constructivism is much broader than psychology. Also addressed in this interview were the practical applications of constructivism to the domains of public policy, education, community relations, and to the analysis of politics. In many respects, constructivism can be strengthened by its application beyond psychology.

If we were to be "exquisite listeners" to the language of these two leaders, several additional themes emerge regarding the future of constructivism. The first pertains to research methodology. Some striking excerpts in this transcript include: "we still need that close analysis of language;" and "[we need] a methodology ... [to] see how people change stories." Don and Bob's language reflects a yearning for some sort of "coding system," "content analysis," "metric," "pragmatic discourse analysis," or "line of research" to better analyze the key elements of storytelling. In essence, a great need for constructivism is the systematic application of a methodology that would allow us to better assess and analyze how meaning systems evolve and transform over time. In doing so, we may be better able to demonstrate--to those both within and outside the constructivist arena--the predictive power of storytelling. In short, to have a greater impact on the field, we must generate stronger methodology.

However, what also emerges from our interview may be considered hopeful, "change-talk" expressions regarding constructivism and its future. The use of pragmatic research methods is described as "entirely feasible to pursue" and as "a game" that we can "play well." Likewise, psychology is portrayed as having gaps that constructivists "can help fill" and theorists are described as ready to "open up" or "embrace" a constructivist perspective. Such optimistic, change-talk language from these leaders is noteworthy. The latter, if modeled well by the next generation, is essential in creating what so many strive to see in constructivism's future: resilience.

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Title Annotation:PART III: CONSTRUCTIVIST PSYCHOTHERAPY
Author:Neimeyer, Robert A.; Meichenbaum, Donald; Stanley, Caroline M.
Publication:Studies in Meaning
Date:Jan 1, 2015
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