What Corey describes as “postmodern” therapy is, in reality, largely a series of evolutionary changes. Recalling how evolution works — in which organisms change form ultimately as an adaptive mechanism — might be useful here, insofar as many of these “postmodern” approaches seem adaptive in terms of the actual climate of opinion concerning psychotherapy and its medical utility. The chief example that I am thinking of here is “solution-focused brief therapy.”
The notion of “solution-focused brief therapy” would have caused Sigmund Freud to spin in his grave, considering Freud devoted an entire book, entitled Analysis Terminable and Interminable, to the question of whether psychotherapy should ideally last forever. However the widespread cultural rejection of the Freudian paradigm is, perhaps, one reason why the notion of long-term Freudian analysis has come to be replaced with the fast food approach. But the chief reason appears to be adaptive: increasingly health care plans and HMOs will only cover 10 or 12 therapy sessions, no more. For the patient who finds therapy necessary, it is encouraged to pay out of pocket for additional sessions, which many patients are simply unable or unwilling to do. This is why I describe the new direction of “solution-focused brief therapy” as an evolutionary change: resources are no longer sufficient to support the Freudian dinosaur, so therapy evolves to take advantage of what resources are there. Previous forms of therapy were willing to last for years in order to explore the deepest roots of a client’s behavior and thought: with this new fast-food approach, the assumption is that insurance will cover eight sessions only, so therefore a problem should be soluble in eight sessions.
This is clearly a way in which therapy reflects changing societal values and practices, but I am not entirely convinced the change is advantageous in itself, rather than a necessity based on market pressures. I think the objection is pretty obvious: a client who comes in expecting a radical change in a short period of time is already setting himself up for a radical change, and expecting the therapist to play such a role. It is not hard, for example, in “faith healing” religions to persuade people to experience psychosomatic miracle cures. To some extent, I feel like the solution-based approach is putting the therapist in the position of acting like a faith healer, and essentially standing in to shepherd some kind of miracle cure that is actually being generated by the patient himself or herself. This seems to be a radical transformation of the old notion that therapy had to begin with the patient wanting to change — now the behavioral change is entirely the focus and the therapeutic process has shifted its methodology from a slow facilitation of patient self-understanding to a rapid delivery system.
If there is a form of postmodern therapy that seems more persuasive to me, however, it is narrative therapy. This seems to be like postmodernism in its good sense. If a postmodern film is one that is aware of its status as a film — i.e., the characters address the audience directly or comment on the movie itself — narrative therapy is aware of its status as therapy. In other words, it locates the focus of difficulty in the patient’s narrative — his or her way of telling stories about himself or herself. So to a certain extent, narrative therapy is basically just a self-aware form of the old psychotherapeutic paradigm — the chief difference is that now the patient is encouraged to listen, interpret and analyze his own narrative, with the understanding that narratives have consequences. This, I think, is a valuable approach, even if ideally it requires a longer time process than an insurance company might be willing to bankroll. But obviously the changing societal values and directions that it reflects are, themselves, constituted by narrative.
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