Pluralism: Beyond Therapeutic Integration?
Helen Smith, John McLeod, Brian Rodgers
The following email dialogue, from the pluralistic practice network, explores some key questions about the nature of pluralism in therapy and its relationships to integrative and other practices. It begins with a question from a trainee:
Helen Smith (18/5/2022)
There was discussion about pluralism at college this week and I thought some in this group might be interested at the perceptions within college as this is the next people joining the profession. The idea that pluralism is a type of integration was suggested. The difference between pluralism & integration was described as:
Integration is one foot in each modality at one time while pluralism is moving fully from one modality to another (e.g. being fully TA or fully CBT) within that session/part of session. Eclectic is seen as a more random scatter graph of bits of different theories.
As my mind tried to race through all the bits I’ve read on the website blogs, heard in meeting, read in emails. I recalled one which I shared with my college group: The idea that a basic pluralistic concept is that different clients work in different ways, therefore an acceptance that one modality won’t work for all clients.
Any thoughts and feedback gratefully received as I wasn’t entirely convinced in the lesson but wasn’t confident enough in my understanding to question tutor further.
John McLeod (19/5/2022)
The concept of pluralism reflects a philosophical position that has major implications for how one might make sense of reality and human relationships. The application and interpretation of that concept to psychotherapy can be (and has been) understood in many different ways. For me, one of the precious aspects of the pluralistic practice community has been open-ness, acceptance, curiosity, and dialogue around this diversity of ways of seeing pluralism.
For me, the heart of pluralistic therapy lies in the different ideas, life experiences, healing strategies, etcetera, available to, or held by, the client and the therapist. What makes pluralistic practice distinctive is a commitment to engage in dialogue and shared decision-making that supports a process of co-construction or co-creation of a way of working together that makes best use of the life experience and knowledge of both the client and the therapist. This process is enabled and facilitated by a whole list of pluralistic skills and ideas: goals, tasks, methods, shared understanding, collaborative case formulation, both/and thinking, broaching, care, metacommunication, cultural resources, feedback, etc. I would see these as comprising current best knowledge around how to work together from a position of co-creation. Colleagues are (and always will be) constantly adding to this list, and producing new ways of implementing existing strategies.
I personally regard existing therapy approaches (psychodynamic, CBT, Gestalt, person-centred, etcetera) as a relatively minor strand of pluralistic practice. For therapists (and some clients) they function as a reservoir of useful ideas, images, narratives, psycho-educational tools, metaphors, therapeutic activities, etc. But they need to be seen as existing alongside many other ways of knowing and doing that are available to both client and therapist: cultural resources, personal life experience, concepts and change activities from other disciplines (e.g., art, theology, human ecology), concepts and change activities from indigenous/first peoples cultures, etcetera. In addition, we all possess highly complex interpersonal skills (and counselling skills) that support a capacity to improvise new healing activities and ideas in the moment.
I personally regard an approach to pluralistic practice that is based in choosing between therapy modalities (‘let’s start with person-centred exploration and then move to CBT-type behaviour change’) as unhelpful. Yes, this sometimes happens, but I believe that if the therapist and client are truly open to considering all possibilities, the therapy ends up as consisting of a mix of cultural resources, impro, personal knowledge, and bits and pieces from therapy approaches.
Yes, pluralistic practice can be viewed as a form of integrative therapy because it combines more than one therapy approach. But at the same time it is fundamentally different from other integrative approaches in its commitment to shared decision-making, cultural resources, and a general move away from an expert-driven stance. I have written about this in several places.
Brian Rodgers (19/5/2022)
Thanks, John, for this lovely gift of insight. I would also humbly add that for me, the pluralistic perspective opens the door for more than just drawing on a plurality of approaches, but to engaging respectfully with completely different ontologies and ways of ‘being’ in this world. This includes more than acknowledging a plurality of cultural resources, but also acknowledging that Western counselling/psychotherapy traditions arise from a very culturally located history of understanding the psyche, personhood, identity, communication, encounter etc. This opens the way for considering how even the concepts of and engagement with dialogue, shared decision-making, co-construction and co-creation are culturally bound.
This, to me, is an incredibly exciting opportunity for the field of counselling/psychotherapy to come into relationship with completely different ways of knowing and being in this world, and to discover through encountering this ‘other’. This, to me, is the heart of pluralism… that even the ‘pluralistic approach’ is just one of many possible ways of doing/being etc. It invites me to hold my ‘knowings’ lightly, tentatively encountering the ‘other’ with the knowledge that the very way that I see and experience the world is conditioned by generations of (Western) culture.
In Aotearoa New Zealand we have the huge privilege of having this opportunity presented to us on almost a daily basis. Māori, the indigenous people of this land, have a history of a completely different way of being in and seeing this world. Through this process of encounter arise opportunities for ‘experiments across worlds’. I would encourage anyone who is interested in this to have a read of Anne Salmond’s book Tears of Rangi. It offers profound insights into how fundamentally different Western/European versus Māori/Pasifika ontologies are, and some of the implications of this.