Constructivism (#6)

Posted by pcousineau on January 27, 2014 in Uncategorized | 2 Comments

The issue of self-worth has triggered a lot of thinking in my friends’ circle. After my blog “Lucien’s question”, I received this comment from my long-term friend Louis. He is a much-experienced psychiatrist who has always loved to practice and teach psychotherapy. He is a specialist of cognitive-behavioral approach and has played a significant teaching role in French speaking Quebec.

 

 “Does a person who suffers from an anxiety disorder, who is chronically worried, and who is doubtful of everything wouldn’t automatically be doubtful about its personal worth, and so have a Defectiveness schema, accompanied by Approval Seeking (compliance to others) and Unrelenting Standards (compensation – if I succeed, I’ll be valuable) schemas? In this case, shouldn’t psychotherapy aim be to help this person accept and cope with those deficient schemas instead of trying to change them since in our actual state of knowledge, anxiety disorders can’t be cured? And, considering the fact that there are a lot of persons who are worried and doubtful about themselves, wouldn’t that partly explain the observation that so many of us keep longing for approval and recognition in our actual living space?”

 

So this constitutes an occasion to share Louis’ point of view with my blog’s readers.

 

Since Louis and I know each other well and have had many discussions over the years (they are now less intense since we are getting older), his point of view wasn’t a total surprise to me. But, this time, what struck me most is how two reasonably intelligent persons (I hope this is also true in my case) can sometimes have such different perception and understanding around the same issue. I thought this would be an opportunity to introduce more substantially my basic philosophical point of view, constructivism. Reality, at least for us (human beings), is always described through our construction of the world. And no story is true, although certain stories look truer than others (greater integrative power).

In this particular situation, I don’t know which story (Louis’ or mine) is truer, but I thought it would be interesting to present two constructions of reality from two long-time friends who have never totally succeeded to convince each other.

Although I agree with Louis as to the probable trait dimension of anxiety (I am thinking to Eysenck’s neuroticism dimension for example), I have a tendency to work with it in the context of a psychological understanding. My perspective on anxiety is more phenomenological: the presence of anxiety suggests that something in the psychological realm of the person isn’t really assumed, there is something the person resists to see, hear, feel, be conscious of. Here are a few examples:

 

– I am scared to assert myself at work and I am not looking truthfully and mindfully at the basic content of my fear (for example, I am convinced that I can’t make it in life without this specific job).

– I disagree with my spouse’s attitude, but I can’t look honestly at this dissatisfaction since it would trigger my fear of abandonment.

– I am not used to take account of my preferences and I am lost when I have important life commitments to make.

– If I have the feeling that I am not controlling everything, I have the vague apprehension that everything will fall apart. So I can’t let myself be spontaneous and every personal longing jeopardizes this need of control.

– Acknowledging the presence of anger in myself would trigger memories of severe punishment; so better to dismiss it.

 

In contrast to anxiety, fear is a basic affective system, it tells me what is dangerous and indicates me what I have to do (run away for example). In anxiety, it is difficult to take action because I don’t really want to face truthfully what threatens me. So it is a kind of diffuse fear response without straightforward defined aim. Anxiety is like fog, it may hide many kinds of issues. With this kind of comprehension, it becomes easy to understand why clarification of the issues behind anxiety is an important aim in my psychotherapeutic interventions. For example imagine a situation in which panic attacks in a woman could be linked to a Subjugation schema in a very dependant person; the slimmest building up of anger towards her husband triggers high anxiety levels (the perspective of assertiveness and possible retaliation from her husband is too much threatening). I have already observed that the clarification of this process may be sufficient for significant anxiety decrease even if the couple’s issues weren’t yet resolved. The fact she was feeling bad in certain contexts had now a meaning, it now made sense to her.

 

Louis and I are experienced clinicians and won’t apply our general philosophy of intervention in a rigid way – I may, for example, get the impression with a specific client that neuroticism traits coming across are so salient that they seem to deter my habitual psychological strategies. But nevertheless our prevalent philosophy will have an effect on our way to construe clinical understanding and therapy goals – for example “to help this person accept and cope with those deficient schemas instead of trying to change them” or help this person clarify pro-symptom positions with the aim of modifying a schema (like Subjugation schema in my last clinical example).

 

Which is the best option (or truer)? I don’t know. But from what I do know, I doubt there could be a definitive response to this. For sure, an important criterion should be the effectiveness of the clinical intervention. But like Schrodinger’s cat famous story (quantum physics), the criterion for effectiveness may have to do with the observer. From what I know, most our respective clients have found our interventions useful. Moreover, Louis and I have the intuitive wisdom to refer to each other clients that seem to fit better with our respective way to see the human psyche.

 

pcousineau