Discursive Psychology: Meta-theoretical applications for clinical Psychology

Tunbridge, Mark

Discursive Psychology: Meta-theoretical applications for clinical Psychology

Doctoral Thesis

2000

Abstract

This thesis proposes how Rom Harre's meta-theory for (social) psychology (Discursive Psychology) might be applied to the typical concerns of mainstream Clinical Psychology, namely, DSM IV diagnosis; clinical formulation; treatment intervention; and therapeutic evaluation. Discursive ' Psychology is posited as an overarching meta-theory for the social institution of Clinical Psychology, which is conceptualized as a phylogenetic discursive artifact (Vygotsky, 1962). The conjunction of these two divergent paradigms forces novel, emergent clements which might be usefully applied in efforts at improving both theoretical and applied psychotherapy. This is possible since all psychotherapeutic activity must necessarily include two interrelated, implicit first premises, i.e., 1) social discourse; 2) persuasive rhetoric for motivating healthful change in therapeutic subjects on the part of the psychologist as therapeutic agent. Discursive Psychology therefore provides an ideal, subsuming meta-theory which might inform therapists attempting to integrate the strengths of diverse schools of psychotherapy into one coherent formulation since social discourse, therapeutic or otherwise, is the essential subject of its investigation. Discursive Psychology also informs Clinical Psychology through its rich empirical research heritage - this can be adapted for the pursuits of clinical work, thereby augmenting the Clinical Psychology discursive artifact still further. This thesis attempts to explore the theoretical and pragmatic implications of these claims through philosophical argumentation and empirical investigation (case study analysis). This claim is possible given that optimal counterpoising of the meta-theoretical strengths and weaknesses of Empiricism, Rationalism (Scientific Realism) and Social Constructionism makes Discursive Psychology the ideal heuristic ('toolkit') for conducting practical clinical work, since the theoretical integration of diverse schools of psychotherapy is so facilitated. It is therefore claimed that 'discursive clinical psychology' provides a coherent, professionally accountable meta-theory for the concerted application of existing therapeutic principles, strategies and techniques ('tools') as these inform a range of psychotherapeutic schools of thought, thereby availing practitioners of an optimal therapeutic discourse. This might be fashioned into a 'working eclecticism' in psychotherapy devoid of the usual theoretical anomalies which plague clinical eclecticism. These assertions are demonstrated both philosophically (Part I) and empirically (Part m in three detailed case studies of situations typically confronting the psychotherapist in contemporary clinical practice. Chapter 1 reviews how three central philosophical contentions have been addressed in Clinical Psychology over the past century; that is, biological versus social considerations; individual versus collective dimensions; and cognitive versus affective elements. A cursory historical analysis of the V following psychotherapeutic schools was undertaken in this regard: psychiatric, psychoanalytic, cognitive-behavioral, humanistic-phenomenological ( client-centered, gestalt, existential), systemstheoretical (strategic, structural, Milanese, eco-systemic), narrative therapy, and, radical therapeutic deconstruction. The resulting analysis provides the philosophical substratum for the ensuing discussion outlining the theoretical basis of a possible discursive clinical psychology formulation. The following three chapters therefore focus on Harre's meta-theory through a discussion of - his theoretical biography as this evolved over time into the mature Discursive Psychology formulation, and is outlined in Chapter 2; developmental concerns, and notions of psychological change more generally are considered in Chapter 3; the evolution and nature of the diverse research instruments ('tools') available in Discursive Psychology research methodology is discussed in Chapter 4. Chapter 5 is devoted to a theoretical synthesis of traditional Clinical Psychology activities with those of Discursive Psychology. These notions are integrated conceptually with the assertions made in the preceding philosophical and theoretical review into a coherent discursive clinical psychology formulation, which concludes Part I of the thesis. This provides the theoretical template for guiding therapeutic discourse during the process of facilitating discursive therapy interventions and is demonstrated in the ensuing case study illustrations and discussion. Part Il opens with an outline of the empirical research procedure adopted as this changed over time (Chapter 6), followed by three further chapters devoted to a discursive clinical psychology analysis of each case study m1it. These function as illustration of how traditional forms of psychotherapeutic intervention typically used by the contemporary psychotherapist might be constructed from a Discursive Psychology position. That is, Chapter 7 discusses the collective Wlit - a depressed child and his family, and includes individual play and collective family therapy sessions; Chapter 8 focuses on the dyadic Wlit - a sparing couple attempting to create a reconstituted family, and includes couples therapy sessions; Chapter 9 considers the individual unit - a certified psychiatric patient whose disability grant is threatened, and includes examples of individual psychotherapy sessions. Each case study includes full transcripts of sessions, and is enclosed on a CD-ROM using the Adobe Acrobat™ PDF format. The transcripts are indexed to clinical discussion during the course of the chapters, focusing on research, diagnosis, intervention and evaluation, as informed by discursive therapy principles, strategies and techniques. The final chapter provides a brief critical review and summary evaluation of the discursive clinical psychology project as a whole, and outlines the way forward.

Keywords

Psychology

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PhD / Doctoral

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