Paper presented at the 3rd Annual Qualitative Methods Conference: "Touch me I'm sick"
8 & 9 September 1997, University of South Africa Regional Office, Durban

Politicising the Therapeutic Relationship:

Same-Sex Desire and its Contested Truths

Anthony Theuninck

University of the Witwatersrand

[email protected]

Contextual Comments

This paper seeks to find a way of thinking about what the epistemological limitations are of therapy and to conceptualise the client's points of agency or conviction in herself that moves her to empowerment. At the conference it was mentioned that the therapist herself may also have points of conviction about the client. The question is, how should the therapist honour her own convictions? Although the paper does not answer this directly, the message it conveys would suggest that the therapist's convictions should always be more suspect than the client's. This is because they are about another person and may thus serve as a way of talking about the therapist's self and especially her world, under the guise of talking about another. This would not mean that the therapist must not go with her convictions or intuitions about the nature of the client's distress. It does mean that the therapist is to value her convictions as secondary to those of the patient. The patient is the one who finally walks away from therapy to utilise the relational experience of therapy in the real world. The client learns that there are ways of relating to others whereby one's self becomes more discernable and one's self-interacting-with-others also becomes more conceivable, understandable or `realistic'. Since the onus of cure ultimately lies on the client, it is up to the therapist to suggest her own convictions about the client in a way that allows their constant adjustment to the client's own convictions. Cognitively speaking, whether the therapist's interpretations or reflections are merely accommodated or actually assimilated by the client's schemas, does not depend on the truth content of the therapist's convictions and her ability to convince the client of that. The therapist's conviction in her own truth is liable to dominate the client. Rather assimilation or even the more extensive accommodation should be primordially led by the encouragement of the client's convictions to choose and determine for herself what the best way is of understanding herself and the world.

The therapist embodies two forms of knowledge. The first is propositional or theoretical knowledge which may be divided along deterministic or free will ontological lines. The second is the therapist's processual knowledge which is the situational application of propositions through narratives in order to make sense of the clients idiosyncrasies. This knowledge is occurs within a paradoxical hermeneutic circle i.e. to make sense of the facts presented by the client we must be able construct a coherent narrative that is unavoidably biased by our values, but before we can create this narrative we need to know what the facts are. Within propositional and processual knowledge we find unresolveable Gaps or lacks of reaching objective understanding. By becoming aware of these Gaps and acknowledging them as the limits of the therapist's knowledge, we can work towards preventing the domination in therapy and promote a co-constructionist view of knowledge in therapy. The awareness of these Gaps may be mainly achieved by the virtue of self-reflexivity. Preventing the domineering exercise of power may be further enabled by encouraging the agency of the client through honouring the client's convictions. In order to illustrate the points of the paper reference is made to the ways in which client struggles around same-sex desire may be treated without biasing treatment to either change or reaffirmation of the desire.

The Problem

Therapy is about facilitating going on being, enabling the flow of life. But this is too romantic a picture which forgets that to be in this world is an experience steeped in constraints imposed by disciplinary systems and natural limitations. These constraints are also partialled out unequally amongst different Beings.

Any therapeutic endeavour occurs within this system of inequality and constraint and much of the therapeutic effort is to help the person find a balanced fit within the systems of constraint. By "balanced" I mean being able to assert yourself creatively or pro-actively without falling into irrational routines of compliant obsession or antisocial outbursts of aggression.

Despite this goal it would seem that therapy has emphasised "fitting in" more, and "balanced" less, for some people than for others, emphasising constraints more and proactive assertion less. Therapy has at times reinforced the dominant forms of inequality. In such cases therapy falls prey to the charge by Jeffrey Masson (1992:245) that it is a "process whereby the bland teach the unbland to be bland". People who have same-sex sexual desires have suffered much under this bias. The questions we need to ask is how the therapeutic process (as dominantly or modernistically conceived of) promotes such bias and, what form of thinking can contribute to preventing such mistakes?

To answer this question we first require a dissection of the forms of knowledge that operate within the one-on-one psychotherapeutic setting. The differences in psychotherapies make a global analysis (as is attempted here) somewhat problematic. The following argument thus requires the reader to suspend such critique for a while in order to allow the author to elucidate a way of understanding therapeutic interactions that could be more or less used to understand all strands of interactions. The project we embark on is one of entertaining the utmost doubt about the legitimate knowledge of the therapist. In order to ascertain this doubt we need to deconstruct the therapeutic process. This requires us to paint a static picture of this process, which is a necessary fiction and must be seen as such. This static picture will allow us to segment and categorise the aspects of therapy and then to destabilise them or show their lacks or gaps. Whilst the reader may retort that this is an exercise in fantasy, it must be noted that all theoretical descriptions of processes are fictions. The very act of writing about therapy unavoidably creates its own static fictitious impression of the process whereby it seeks to advance a particular `truth' about that process. Alas we have little option but to engage in rigorous fiction. This will create a form of understanding that may provide new questions and new doubts with which we can re-enter the process and avoid succumbing to the numbness of routine and dominantly accepted fictions.

Three Forms of Therapeutic Knowledge

The first form of knowledge operant in the therapeutic interaction is the therapist's knowledge. This knowledge may be differentiated along theoretical and pragmatic lines. As a theoretical construct, knowledge is an abstracted system of statements which we will term propositional knowledge. Propositional knowledge (knowledge of theory and empirical findings) may be differentiated by its adherence to either the ontological assumption of determinism or free will.

Processual knowledge come into existence via utterances made by the therapist. These utterances do not reflect a neat single body of theory, but an ensemble of concepts that reflect the therapist's understanding of the client and her pragmatic intention to influence. The assumption is that no therapist, no matter how well trained, acts like a programmed instrument of theory never deviating or introducing idiosyncrasies into her understandings. The therapist's utterance (processual knowledge) draws on her propositional knowledge. Processual knowledge is the application of propositional knowledge to the therapeutic situation. Processual knowledge is contextual and specific to the therapist-client interaction. These distinctions will be dealt with in more depth later on.

The interaction of the therapist with the client constitutes a second source or form of knowledge. This form of knowledge can be labelled as co-constructionist. For the moment suffice it to say that co-constructionist knowledge is an understanding, derived at by both the therapist and client, that constructs the client's presenting problem and solution.

The third form of knowledge may be deemed the client's knowledge of herself. It is this knowledge that is the precondition for the therapist's processual knowledge.

Knowledge Bias in Therapy: Therapist's and Co-constructionist Knowledge

In order for a therapeutic discipline to maintain itself as being more than just palm reading or crystal gazing it needs to assert its scientific legitimacy. Scientific legitimacy is constructed by a community of scientists who share certain rules according to which different statements are deemed as knowledge or not. In order to share in the knowledge upheld by a community of scientists a person has to be initiated into it via extensive training. The trained person therefore becomes an expert who applies the knowledge of her discipline to situations and people lying outside of the scientific community and who do not share that knowledge or training.

The process of exchanging knowledge occurs in the therapeutic situation in which the therapist utters certain knowledge to the client that is assumedly supported by a scientific or objective legitimacy. In deterministic forms of therapy, like psychoanalytic or cognitive-behavioural, the therapist's interpretations are more important than those of the client. Little room is made for contestation, since empirical or rigorous theorisation have willed it that the road to health will consist of certain ways of doing or understanding things and not of others. In humanistic therapies the importance of the therapist's knowledge is not acknowledged but operates no less vociferously. Although a humanistic rapport accords the client the primary voice in therapy, the instrument of `cure' will still lie with the therapist. The client will be empathised with and reflected in a way that is consistent with the therapist's form of knowledge of what is required therapeutically. It is interesting to take Roger's Client-Centred therapy as an example. In his major work (1951) there were no less than 15 passages dedicated to the importance and utility of research to validate the therapeutic process. Rogers was thus keenly interested in positivistic evidence that the therapeutic situation, as created by the Rogerian therapist and her reflections, is effective. This modernist view of therapy holds that there is a specific goal that needs to be met in order to declare therapy a success, and that this goal is strongly steered by the therapist.

In the dominant modernist portrayal of co-constructionist knowledge, the humanist therapist merely emphasises the importance of the client's self-responsibility in creating a solution that the client will be happy with; or in deterministic therapy the client is required to assume responsibility for her own `cure' within the new, more healthy worldview that is interpreted as necessary by the therapist. This conception of co-constructionist knowledge is implied to exist between two separate boundaried individuals where the unequal power relation held in check by those boundaries is not brought into question. The client will not be deemed healthy if she insists on being responsible to herself in a way that is oppositional to the therapist's professional understandings. Co-constructionist knowledge is thus down played to the therapist's knowledge. Modernist co-constructionist views are means whereby the therapist ensures the cooperation of the client by giving her the impression that her own choices have led her to come to the insights the therapist has wanted her to have. Utilising knowledge as co-constructionist will inevitably be subordinated to the therapist's knowledge in the modernist frame. This is because the discipline's credibility rests on its ability to verify its scientificness, and this verification rests on demonstrating the skill and knowledge of the therapist.

On the surface this is not outrightly detrimental or problematic. It cannot be denied that to a large extent therapists are being consulted because they do know things substantially different from the lay client and which are of benefit to the client. Yet the importance of scientific legitimacy does down play co-constructivist knowledge to being merely a way of drawing the client into being responsible and choosing her own pathway within the context of the therapist's framework. This bias may have certain limitations that are predominantly unacknowledged.

The Gap in the Therapist's Knowledge

Gap in Propositional Knowledge

What this paper seeks to do is to ask at what point does the therapeutic relationship allow the client fuller participation in defining co-constructionist knowledge? At what point does the therapist's knowledge falter and provide a gap in which the client will have to assert her own knowledge that is in opposition and independent from the therapist? In other words, how can the client show, in what space can she show, what she knows, a knowledge that is not consonant with the therapist's healing worldview, but that might be legitimately opposed to that view? Is there a space within which this could happen or does the legitimacy of therapeutic knowledge ultimately rest with the therapist's worldview? To answer these questions we will examine the interpretative knowledge employed by the therapist. Are there any gaps in this knowledge?

Theoretical/propositional knowledge is distinguished by deterministic and free will ontological assumptions. Following Hanly (1992) we can state that there are two criterions for interpretative truth. The first is the coherence criteria which maintains that interpretation is always a function of our perception and what makes up a valid coherent truth is the systematicness, consistency and coherence of the interpretation. Our second criterion is the correspondence criterion for truth. Correspondence theory states that our interpretations correspond with an actual entity in the world and are not merely functions of our perception. An interpretation can therefore be an accurate reflection of actuality provided biases are taken care of. All therapeutic interpretations are situated uncomfortably between these two forms of truths. Therapeutic interpretations are a reflection of the therapist's understanding as shaped by her perceptions, her systematic narration of what she understands is going on. Yet the credibility of therapeutic interpretations lie in the fact that they do reflect reality or contain fact about the client. The Gap in our knowledge is created by this processes since it is not possible to specify to what extent our knowledge is both a product of perception or a factual reliable observation of the objective, real world.

At this point we need to recognise a paradox in the interpretation of actuality. A theory we have may not be an accurate description of reality as it actually is, but may nonetheless be consistently useful in predicting and/or explaining what is happening within a particular context. An example from physics would be that newtonian physics may not be totally correct but is useful and correct when explaining motion within particular small scale contexts. This paradox introduces the possibility that although the therapist's perception may not be a totally accurate reflection of actuality, it is still functionally/practically useful. A theory or perception may not describe what is really happening but does allow for creating consistent and favourable outcomes. It has predictive value. That is, to all intents and purposes it is correct! This paradox further argues for the existence of the unavoidable overlap between perception and actuality, between coherence and correspondence truth, and by extension, between free will and determinism respectively.

We can therefore formulate the maxim that interpreting or reflecting the client's worldview and road to cure is a product of both the attempt to ascertain the actuality of what is presented, as well as imposing a coherently constructed narrative whereby the therapist creates a consistent, reliable perception of what the client seems to be presenting. It is in this overlap that the Gap of knowledge arises.

Despite this overlap in actuality and perception, different theories and modes of psychotherapy emphasise the one form of truth over the other. Deterministic theories emphasise correspondence truth as a criteria to claim their legitimacy, whereas humanistic, free will theories emphasise the coherence criterion of truth to claim legitimacy. Deterministic validity relies on the claim that actuality is captured by the theory and the theory may consequently be applied prescriptively. Humanistic or free choice theories espouse the importance of the client's freedom to choose and assemble a coherent perspective of her own life story that is effective and accurate for that person. But given the overlap of perception and actuality, each theory's exclusive ontological emphasis resides on the denial of the other. Deterministic theories rely on the client's agency and idiosyncratic execution of its commands, whilst humanistic theories cannot advocate total free choice given their underlying belief in a discernable (objective) truth or goal that each person needs to pursue in order to find contentment or `health'.

No theory can therefore align itself exclusively with either correspondence or coherence truth. Beneficial hermeneutic stories cannot be divorced from a valid empirical description of actuality. Asserting that there can be a divide between the two forms of truth is like asking whether there is a sharp dividing line between discourse and materiality? Foucault (1977) argues in the negative when he exposed the relationship of changing constructs in discourse throughout history and their effects on the social organisation of space. The power of discourse is the ability for stories to have real effects on how we conceive psychological, social, private and public spaces, in ways that actually affect the way we experience ourselves and the world. Kirby (1996) further adds to this that discourse does not enjoy free reign in shaping the world but is constrained and partly determined by the real/actual limitations in the world. At some point hermeneutics or coherent stories are determined by the limits of actuality that shape the story line. Similarly there is a point at which coherent narratives may escape the determinism of actuality and effect change upon it. If discourse and materiality overlap and are mutually effecting, it may be that truth is not to be found in either discourse (hermeneutics) or materiality (empirical realism) but in the relationship between the two.

It should now be clear that the interminable Gap in propositional knowledge is introduced by the fact that no deterministic understanding can be free from the unpredictabilities and idiosyncrasies introduced by free choice to create narrative, as well as that no humanist interpretation can be free from the constraints of actuality. Theoretically the Gap arises in the fact that no theory or interpretation can fully grasp the influence of determinism and free will upon each other. The Gap is our lack of understanding.

Theories that deny that both forms of truth are always in operation, are also attempting to deny the lack or Gap in understanding. This is the signature of modernist therapeutic practices: denying their lack! It is only in recognising the importance of both forms of truth operating in any situation that one recognises the inability to understand the interaction of both truth forms and therefore the inability to understand the other person completely.

Gap in Processual Knowledge

So far we have conceptualised gaps in knowledge in terms of the ontological assumptions of determinism and free will. This has made the Gap in theory apparent to us. In the practical t