The Radical Nature of Pluralism in Therapy
Mick Cooper, Professor of Counselling Psychology, University of Roehampton
One of the challenges to pluralism in therapy, over the years, is that we’re not really saying anything new. The challenge goes something like, ‘Yeah, pluralism, that’s great, but we’re all pluralists anyway. I’ve been doing pluralism for years.’
Being pluralistic, my inclination has been to be accepting of those challenges and broadly go with what people say. ‘Yes, I guess that pluralism is pretty implicit in the therapy world, we’re just trying to articulate that standpoint and make it more explicit.’
And then, sometimes, I have a sense of, ‘No, actually, what we’re saying is something really different from how a lot of the therapy world thinks and see things.’ It’s actually a really radical, different take that challenges some deep set assumptions in the therapy field.
I think what pluralism stands against, in particular, is a kind of hierarchy-ism in the world of therapy. It’s a standpoint that is so implicit, so subtle, that sometimes it’s difficult to really see it. And, I’m sure, most people who hold this way of seeing things would say that that’s not their worldview (so it’s not very pluralistic to propose it!). The basic assumption of this worldview is that there is a kind of hierarchy in the therapy world, or like a ladder. On the bottom rungs you have the clients, then above them you have trainees, then therapists, then trainers and supervisors, then on the top rungs you have the people who write the books (yup, putting myself near the top!), and right at the very pinnacle you have someone, perhaps, like the Chair of the BACP who looks out over us all. And the assumption is that, as you go up the ladder, you are basically more ‘right’–have more worth in terms of views and perspectives–you’re essentially smarter. So if a client challenges a therapist: ‘Hm… that’s interesting, I wonder what that is about that makes the client want to make that challenge?’ Or if a trainee challenges a trainer, ‘So what is it about them that makes them resistant to learning?’ Essentially, the standpoint of the person higher up is always the right one, and the views of those lower down get (subtly) pathologised and problematised: they’re things for that person to look at and work through. It’s a kind of benign paternalism where, while there is a care for those lower down the ladder, they’re also seen as being a bit like naughty children: ‘acting out’ or being disruptive so that they need to be kept in line. And there’s also a wariness or suspiciousness towards those on the lower rungs: you have to watch out because, even if they don’t mean, they’re often ‘up to’ something–trying to get one over on you. So you need your armour of your boundaries and your therapeutic frame to protect you and ensure that you don’t get tricked or manipulated. For their own good, of course.
It’s a model that makes no sense at all. Do you suddenly go from being dumb to being smarter the day you get your Diploma in Counselling, or when you start to supervise? And what happens if you’ve been a trainer and then you go into therapy as a client: do you suddenly become less smart? And what if the therapist that that trainer is then seeing was a trainee not so long ago: has there been some kind of switch around in smartness and rightness overnight? But that’s how the model seems to see it: always the person higher up, by fact of being higher up the ladder, is the one with the right view; and if those lower down challenge that or question their wisdom, it’s their issues; it’s not legitimate, intelligible challenges from other equal human beings.
In my experience, this kind of ladder-like view of the therapy field tends to be particularly associated with a psychodynamic worldview. Psychodynamic thinking introduces, very helpfully, the idea of transference and countertransference; but this conceptual framework also seems to be a very helpful weapon (or perhaps shield), whereby the views of those lower down the ladder can be easily batted away. I’ve seen it over and over again in the therapy field: ‘Mm… the client’s late because he “missed his bus”, I wonder what that’s about?’ ‘Mm… the client couldn’t tolerate that I was a few minutes late to the session because I missed my bus, I wonder why that’s so hard for them to accept?’ Transferential interpretations become a way of twisting whatever is going on so that the people lower down the ladder are always kept in their lower position: like a foot on their head. And, also from a more psychodynamic worldview, ‘boundaries’ or the ‘therapeutic frame’ (again, practices with enormous potential value and importance) are weaponised as means of ensuring that those lower down the ladder stay in their place: ‘Their challenges to me are ways of trying to push my boundaries… I must remain resolute’. What all of this misses, as more contemporary psychodynamic thinkers like Charles Gelso have pointed out, is that transference and countertransference is just one element of the relationship. You’ve also got the alliance–so the focus on working collaboratively together to help people reach their goals–and then you’ve got the real relationship, where we’re just two human beings–both with our own vulnerabilities and expertises–meeting as adults in the world. So while it may be sometimes very useful to psychodynamically interpret the actions of clients, trainees, or supervisees, to always engage in that way–to understand every challenge as ‘acting out’ or ‘resistance’–is to hold a vastly over-simplified view of the relationship.
Pluralism really tries to do away with that hierarchy, that ladder. No doubt there still remnants of it, but a pluralistic worldview really tries to see all of us–client, trainees, trainers, supervisors, writers–as equal adults, with equally worthy views of how things are and how the world works. That’s not to say that a trainer may not know more about the therapeutic process or the different types of therapy than a client. It’s not a kind of pretence that we all have the same understanding. But it recognises that those lower down the chain may have expertise or brilliance in other areas; and that we’re all flawed, vulnerable human beings, mixed in together facing the existential and un-overcomable challenges of life. So, here, those at the top of the hierarchy don’t have all the answers. We don’t know. We genuinely don’t know. And, for me, the existential element here is that we genuinely don’t know these answers because those answers–about how to live a meaningful, satisfying life–are ones that no-one really has any final answers for. Just because you’ve written books about therapy, or teach on a course, doesn’t mean you’ve resolved the existential dilemmas of existence. It’s all one big, great, complex mess, and we’re all doing our best to navigate some way through it.
Here, then, there’s no hierarchy because there genuinely isn’t a hierarchy in the face of the existential dilemmas and paradoxes of life. And the implicit assumption that those higher up the ladder are more right than those lower down is something of a fabrication that creates meaning, creates order, creates safety (for those lower down, as well as those higher up) that gives us all a sense of knowing where we are and what’s going on.
I have often said, one of the most instructive elements for me in my life in the therapy world has been meeting people at the ‘top’ of the ladder and realising how utterly ****ed up they can be: with, for instance, ego needs and vulnerabilities the size of China! It’s really challenged, for me, this hierarchical view of a therapy progression ladder where rightness comes with seniority. And as someone who has, to some extent, reached the higher rungs of this world, I know for a fact that it hasn’t made me more ‘right’, less flawed, more knowledgeable what is true. Yes, there are certainly differences–I’m more able to mentalise, better at relating with others, less reactive–but it’s a matter of degrees, not absolutes, and if I met myself back in my 20s I know that both Micks would have something valuable and worthy to say.
Pluralism, as William James said, is about mess. It’s about recognising the world is a messy place and that there are no easy answers. Things don’t fit well. And, as William James added, that’s not a particular pleasurable or gratifying way of seeing the world–a ladder, where we all know our place, is much neater and clearer. But recognising that mess can also be deeply equalising: because when we see that mess, and acknowledge the super-messy and complex nature of things, it can help us all feel on a par. That we are all working together to find a way through. Some of us have certain skills, some of us have others. Client or therapist, supervisor or supervisee… we’re all journeyers in this messy world to find some satisfying and fulfilling ways of being and we all have things to contribute.
So, at times, I do really feel that pluralism is a revolutionary way of seeing things in the therapy world: a radical egalitarianism that challenges a pervasive, albeit implicit, hierarchy-ism. Approaches like person-centred, humanistic, and existential therapy have gone a long way there, with their emphasis on a democratic client-therapist relationship, and a view of the client-as-expert. But even here, there can be vestiges of a sense that the therapist ‘knows the way’: for instance, in terms of ‘living in the moment’, or ‘being yourself’. And, I’m sure, pluralistic therapists can also get into feeling like pluralism is the answer, and one that we know over-and-above clients’ own struggles and challenges. But, for me, pluralism is ultimately about a deep and genuine humility: one that really looks at all of us, all the way across the field, as having things of value and of worth. The lovely thing about pluralism, for me, is that it is a philosophy which equalises while also holding the uniqueness, distinctiveness, and specialness of each part. It’s not an amalgamated mush: it’s a genuine treasuring of diversity and the differences across us.
Photo by Jené Stephaniuk on Unsplash
4 thoughts on “The Radical Nature of Pluralism in Therapy”
Brilliant Mick! and happy birthday!
Over the couple of days my colleagues and I have been exploring what this thing called pluralism is and I can only be honest in saying I don’t fully get it just yet. However this blog appeared quite unwittingly yet timely and has helped me ‘get it’ a little more. The learning journey never ends!
Great piece. The only quibbles I would have with it is that I don’t think ‘hierarchyism’ is that implicit and subtle in the therapy world. Most obviously in the ‘psychotherapy’-is-superior-to-‘counselling’ view, for which there is little if any evidence. Indeed it could be argued that the whole SCoPEd project has been about institutionalising this view if the hierarchical titles of ‘psychotherapist’ and ‘counsellor’ are eventually what substitutes the generic A, B and C that we have at the moment. The privileging of understanding transference-countertransferece relationships is also in that model. I would suggest that understandings and ability to faciliate all 5 types of therapeutic relationship (as ennumerated by Clarkson in 1995) would predict the skills and abilities of therapists far more accurately than how SCoPEd currently articulates its perception of what makes a good therapist.
This article helps me understand pluralism a bit better (it’s an ongoing process) as a trainee. However, I’m reminded of John Hick’s work on religious pluralism. If all religions are merely different paths to the same goal then we can all forget different world-views and truth claims and just be nice to each other. But what then about having a deep and embodied experience of faith? So too with pluralistic counselling. If pluralism is ‘better’ at being non-hieararchical, is it positioned above the other approaches? As a trainee in pluralism, I sometimes feel that I’m invited to hover round, and nibble from a buffet table groaning with theories….but longing to sit down for a complete and satisfying meal. Addressing the power imbalance between counsellor/client and trainer/trainee will always be an issue, surely?