Relational Therapy: Constructivist Principles to Guide Diversity Practice

Abstract

This chapter argues for the synergy between principles of relational therapy and the ontology of qualitative research methods. Specifically, both qualitative research and relational therapy call on both the professional and the subject or client for self-exploration to understand diverse populations and the theory that informs their assessment process.

Methods from four qualitative research traditions, ethnography, phenomenology and hermeneutics, grounded theory, and heuristics were reviewed to construct a Bricolage that relational therapists could draw on to learn more about the cultural experiences of their clients.

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Introduction

A central claim of clinical social work is its commitment to serve marginalized and diverse groups of people. Achieving cultural competence is fundamental to social work education and built into the Education Policy and Accreditation Standards of the Council on Social Work Education. At the same time, social work is a profession that asserts expert knowledge recognized by a license following an advanced degree. The purpose of diversity curricula and training is to enhance social workers’ knowledge and practice with different groups of people they identify as marginalized, oppressed, or simply different. In the case of clinical practitioners, years of supervised practice and specialized training increase social worker’s self-identification as authorities about the lives of other people. The irony in this relationship, where professionals claim expert knowledge about subjugated others, is that the power associated with becoming an authority about other people risks disqualifying the experiences of the very people clinicians strive to understand.

Two decades ago, Hartman (1992) recognized this paradox and described how unitary knowledge excluded the lived experiences of subjugated groups. In contrast, when people sought to define themselves, they were able to validate their own truths. In the last century, these actions were evident in the political acts and written words of Black Americans, women, homosexuals, immigrants, and people with mental illness. By advancing their own aspirations and ideas about themselves, they were able to override the ways in which powerful experts defined them. Through their own words and actions, they replaced the “expert” knowledge of others with expressions of their own experiences (Hartman 1992). Hartman wanted social workers to interrupt the power disparities between themselves and their clients, examine their roles as experts about the lives of other people, and reject the idea that clients were simply passive recipients of professional ministrations (Hartman 1992). Awareness of the theoretical underpinnings that may unconsciously guide learned expertise allows the practitioner to greater self-evaluation and relational authenticity in the relational clinical encounter.

Currently in social work education, infusion of cultural content throughout the curriculum or courses to develop knowledge about specific cultural and ethnic groups are central vehicles for producing culturally competent practitioners who can work with diverse populations. In addition, widely disseminated training programs such as “Undoing Racism” (James et al. 2008) or curricula developed through an anti-oppression lens (van Wormer and Snyder 2007) are meant to sensitize social workers to the experiences of diverse groups and the effects of White privilege, class, or cultural bias on their practice. However, the outcomes of these efforts may not be effective. Anecdotal reports suggest that White social work students may feel burdened because of their own perceived privileged status (Abrams and Moto 2007), and the persistent silence of ethnic and racial minority students in the classroom frustrates discussion of diverse life experiences (Ortiz and Jani 2010). Critics of diversity curricula note they “rely on the production and circulation of generalizations and the making of grand summary statements [that] tend to be violent, colonizing, and possessing only a pretense of objectivity” (Furlong and Wight 2011, p. 48). In addition, when cultural competence is only an add-on to professional education, it may not promote the need for practitioners to develop their own capacity for the self-reflection necessary to engage in unearthing their own ideological and cultural values (Furlong and Wight 2011) essential for diversity practice.

This leaves many clinical social workers pessimistic about the state of diversity practice and searching for alternative conceptual models to promote enduring cultural competence for practice. On a more positive note, some social work professors have integrated constructivist concepts, an epistemological way of knowing that rejects unitary knowledge, and emphasizes qualitative research concepts such as the social construction of meaning into courses with cross-cultural content (Lee and Greene 1999). For example, in Finland, educators used discourse analysis to focus on conversations of cultural meaning between social workers and immigrant clients as a methodological tool and a resource to explain the ordinary and common in immigrant’s lives. In this way, they were able to access the individualistic and dynamic ways in which culture played out in a transitional and global context (Anis 2005). More recently, Furlong and Wight (2011) promoted the concepts of “curiosity” and “informed not knowing” so that the clinician positioned the client as the expert and the worker as the knowledge seeker. In addition, they asserted the clinician should regard the client as “a mirror upon which the practitioner can see the outline of their own personal, professional, ideological, and professional profile” (p. 39).

These efforts suggest that constructivist approaches might provide clinicians with strategies they can apply over a lifetime of combined self-reflection and knowledge seeking and a greater possibility for understanding the diverse experiences of clients. This supports the notion that achieving diversity practice is a lifelong endeavor (Furlong and Wight 2011; Kincheloe 2008). Even Hartman touched on the language of qualitative research methods. For example, she referenced “bracketing,” a qualitative research concept that calls for setting aside one’s own experiences when interacting with another person to allow for the expression of the other person’s own worldviews. In this way, she advanced the idea that diminishing the power between researchers and subjects, or by extension practitioners and patients, could produce better representations of clients’ experiences. She suggested that augmenting the voices of subjugated people could not occur through an epistemological approach that assumed the existence of an objective reality outside of the person under the control of elite groups (Foucault 1980; Hartman 1992).

In contrast, social worker’s application of constructivist knowledge building approaches or qualitative research methods might help clinicians transcend their own worldviews in a therapeutic relationship so that those of their clients could emerge (Abrams and Moto 2007; Lit and Shek 2002; Opie 1992; Williams 2006). Methods drawn from a particular ontological view of knowledge building suggest a route for how relational clinical practice might elevate the truths of clients’ experiences and reveal the highly individual, contextualized experiences of people whose lives are different from those of their therapists.

This is a radically different way to augment the perspectives of diverse groups within therapy. It suggests that the therapeutic relationship is a potential venue where the therapist and the client can build contextual, linguistic, intersubjective, and social knowledge together (Kvale and Brinkmann 2009); this would enable clients to project the subjective realities within them into the clinical relationship. Although there is always inevitable power asymmetry between professionals and their clients (Karnieli-Miller et al. 2009; Teram et al. 2005), a clinician’s desire (Furlong and Wight 2011) to learn about how patients experience and perceive their own worlds positions them to transfer their authoritative knowledge to clients, the true experts about their everyday lived experiences.

This chapter makes an explicit connection between constructivist research methods, those in various traditions of qualitative inquiry, and relational clinical social worker’s attunement to the experiences of diverse populations. I use the terms “constructivist research paradigm” and “qualitative methods” interchangeably and explore a modest range of qualitative research traditions that have the potential to enhance diversity practice. Similarly, I use the term “culture” or “cultural group” to refer to any group of people who interact together over time and develop distinctive features. I propose that it is unlikely through reading, conducting research that distills the experiences of diverse groups, or training and course work alone that social workers learn about cultural variation. Instead, when clinicians gain access to how individuals construct their unique and evolving identities, they can understand them best.

Strategies drawn from constructivist research methods have the potential to help us unearth the lived experiences of people who are our clients. Imbedded in constructivist transactional and subjective epistemology (Lincoln and Guba 2003) are methods that can help clinical social workers understand the cultural distinctiveness of individual people. Although knowing about cultural variations among clients might provide starting points for diversity practice, these can only serve as “sensitizing concepts” or conjectures for understanding other people; it is through discovery of indigenous experiences (Patton 2001, p. 278) of individual clients that ultimately confirms, disconfirms, or entirely transforms a clinician’s understanding of their client’s realities. Generalizations about particular groups may be useful for the practitioner, but they should never be assumed as universally true (Furlong and Wight 2011). This stance allows for the particular representation of the meaning of culture in a client’s life experience to emerge both temporally and contextually. Otherwise, clinicians will not be able to keep pace with the “moving target” nature of diversity practice with clients who live with us in a rapidly changing environment (Ortiz and Jani 2010).

A constructivist approach is particularly aligned with relational clinical practice, because it assumes the active engagement of both the researcher and the informant – or the emersion of both the therapist and the client – in a process of discovery consistent with cocreated interaction and learning (Pozzuto et al. 2009). The purpose of research is to generate knowledge. This is different from psychotherapy, where the therapist’s role is to enable a client in some way. However, relational therapy and qualitative research share many attributes. They both call for elements of mutual discovery within a process that involves engagement and examination. They both have transformative potential (Finlay and Evans 2009). The relational therapeutic consultation is a conversation with features similar to qualitative inquiry. It is a venue where therapists can listen and respond openly without insisting that their particular beliefs, values, or assumptions about those of others are the right ones (Barrineau and Bozarth 1989). Strategies qualitative researchers employ have the potential to help relational practitioners gain entrée into worlds beyond their own (Frie 2010).

Introducing the Bricolage

Bricolage is a French word that translates as a “handyman” or “jack of all trades,” a person who employs whatever tools he needs to get the job done. Levi-Strauss (1968) contrasted these “tinkerers” with skilled craftsmen who operated as technicians and followed a precise method. Denzin and Lincoln (2004) extended the concept of Bricolage and drew parallels between the work of qualitative researchers and that of bricoleurs. As bricoleurs, researchers employ whatever methodological strategies are necessary within the unfolding context of the inquiry. With this in mind, rather than locate a single qualitative method that will inform diversity practice for relational therapists, I propose scouring qualitative research traditions for methodological elements that might prove useful for diversity practice.

By proposing a Bricolage of methods drawn from several qualitative traditions, I highlight the synchrony between qualitative research and relational theory in clinical social work practice with different groups and propose a flexible guide for diversity practice. Drawing on various elements from an array of qualitative research traditions, the relational therapist can develop a repertoire of strategies to enhance diversity practice rather than follow specific steps associated with a single tradition. In this way, clinicians can apply a range of tactics to uncover the realities of their clients’ lives (Kincheloe 2001, 2005; McLeod 2001; Warne and McAndrew 2009). Here I familiarize relational social workers with the roots of these concepts and language for strategies they can select in their roles as bricoleurs as circumstances develop over time.

The Bricolage is particularly well suited for relational diversity practice, because of its grounding in egalitarian relationships and because it values unearthing subjugated knowledge. In addition, it demands self-awareness on the part of the clinician within the complexity of the lived world of their clients. Kincheloe (2008) describes those who practice as bricoleurs as “detectives of subjugated insight” (p. 336).

This chapter begins with overview of the development of scientific knowledge in the modern age beginning with a rejection of the medieval embrace of received beliefs and the adoption of positivism for research about human experiences. Following a summary of constructivist inquiry and principles associated with qualitative methods generally, I provide brief overviews of several traditions of qualitative research that have elements particularly salient for the relational therapist; methods from these traditions will form the basis of a Bricolage for diversity practice. Then I indicate how clinicians in relational therapeutic practice can employ methods associated with these traditions to support the revelation of diversity. Taken together as the Bricolage, these concepts offer a “way into” the social realities of clients towards enriched diversity practice.

Modern and Social Constructivist Perspectives

Positivism and the Modern World

Most social workers understand the distinction between positivist and constructivist research as the divide between quantitative and qualitative research methods. The positivist, quantitative approach is the more familiar (Giorgi 2005) and the most conventionally “scientific” (Thyer 2008). This is the case although qualitative research is a vibrant and growing method of inquiry in the postmodern world (Lit and Shek 2002) to the point where some describe it as an “indispensible part of the methodological repertoire of the social sciences” (Jovanovic 2011, p. 1). However, the paradigm debate extends beyond techniques. Positivist and constructivist research have divergent ontological stances and represent different philosophical approaches to the nature of inquiry. Overall, science is a systematic quest for knowledge, and within it are conceptual roots that represent assumptions and beliefs about the nature of reality, the study of knowledge, how we acquire knowledge, the relationship between the researcher and the subject under study, and the language that represents what is known (Lincoln and Guba 2003; Lit and Shek 2002; Ponterotto 2005). Different research paradigms represent different approaches to science.

Beginning in the in the seventeenth and eighteenth centuries, the Enlightenment signaled a movement away from Western ways of knowing typical of the Medieval period that relied on religious doctrine and received beliefs and towards modernity. This shift created new ways of understanding the world. Galileo and Copernicus were the first natural scientists in the modern sense of the word. In opposition to a world known only through Christian doctrine, they began the transformation of a subjective world into one that was exact, knowable, and objective (Karlsson 1992; McLeod 2001) through a process of the “mathematization of nature” (Karlsson 1992, p. 412) and a natural scientific tradition of abstracting knowledge of the world. Accompanied by improvements in measuring systems, Galileo made the ontological assertion to measure what could be measured and make measures for anything else (Weyl 1959).

John Locke and René Descartes were the earliest philosophers associated with this approach; they asserted the idea of an objectively knowable world outside of the researcher. In the early 1800s, Auguste Comte applied the label “social physics” to what he would later call sociology. This reflected the belief that the same methods of inquiry for the natural sciences could apply to the study of human affairs. His term for this perspective was “positivism,” which involved developing material explanations for both natural and human phenomena (Thyer 2008). In the nineteenth century when positivism became an organized branch of philosophy, John Stuart Mill (1843/1906) also claimed that both the social and natural sciences should work towards discovering laws that explained and predicted phenomena using the same hypothetico-deductive methods (Karlsson 1992). In other words, he also promoted the idea that the methods for knowing about human beings and the natural world were essentially the same.

For 150 years since then, positivism has been the dominant force in the natural sciences and readily adopted by the social sciences (Lincoln and Guba 2003; Ponterotto 2005). The core of this research paradigm is that the world is made of publically accessible substances that people can describe and observe (Giorgi 2005). For the most part, both the natural sciences and the various human sciences claim these ontological approaches and continue to employ essentially the same methods.

Positivism emphasizes empirical research methods dominated by experimental design, where the purpose is explanation and prediction. The social sciences, including psychology and social work, have largely embraced this picture of an objective reality, and many still affirm psychosocial phenomena are a part of that reality in the same way as the natural sciences (Thyer 2008). Hearkening back to Galileo, a central feature of this paradigm is the application of valid and reliable measures. As such, the language of the positivist paradigm is the language of numbers. Consequently, the methods are chiefly quantitative and manipulative and emphasize the verification or rejection of hypotheses using statistical tests as the product of this repertoire of methodological elements (Lincoln and Guba 2003). Research involves building an “edifice of knowledge,” cause and effect linkages, and the ability to generalize. The conventional benchmarks of positivist “rigor” involve internal and external validity, reliability, and objectivity (Lincoln and Guba 2003).

These are all concepts familiar to clinicians in social work practice. For some, they are the only way they understand “research,” perhaps because in contemporary social work education, research courses emphasize statistics. In addition, evidence-based practice grounded in positivist methods is ascendant, and in the hierarchy of scientific rigor, the randomized controlled trial rests at the top. However, journals dedicated to qualitative research and multi-methods in social work have grown with a corresponding vibrant literature that embraces various constructivist research traditions. In addition, professionals involved in relational therapies contest unitary knowledge, because they claim the positivist paradigm cannot produce critical aspects of knowledge that inform their practice (Aisenberg 2008; Finlay and Evans 2009; Nilsson 2010). It is one reason many psychotherapists look to constructivist research paradigms when they conduct research.

Constructivist Research Perspectives

It is easy to see why Hartman criticized positivism and unitary knowledge for subjugating the voices of marginalized populations. Within the positivist paradigm, researchers establish “real” definitions of the essential attributes of variables. They assign nominal definitions that represent consensus or a convention about how a particular term is used. Finally, they propose operational definitions that specify how they will measure variables. In that sense, researchers are the masters of operationalization, because they control the attributes of a variable, and they decide how they will measure it in their studies.

This lies in stark contrast to the constructivist paradigm where the researcher’s concern is to study “characteristically human phenomena” in a world where man is “an experiencing human creature” (Giorgi 1966, p. 39). Here meaning-making is central to knowledge and involves local and specific realities and constructions of subjective experiences where the context is an essential component of understanding. The intention is not to mirror reality. Instead, constructivists focus on interpretation and negotiation of meaning in the social world (Kvale 1996).

Unlike the positivist researcher who is a disinterested scientist, the posture of the constructivist researcher is that of a passionate participant and a facilitator of multi-voiced reconstruction of human experiences. The critique of positivism for research about people is that “unlike gases or gravity, human behavior is always shaped by context and shaped by time. We cannot generalize about human behavior because human behavior is not a-contextual, nor a-historical, never ungendered, un-classed, or non-racial” (Lincoln 1998, p. 15). In contrast to positivists, constructivists seek forms of knowledge that are context specific and inseparable from granular understanding of race, class, and gender (Lincoln 1998); their commitment is to depth of knowledge and probing understanding the human condition. When phenomena appear, they do so within a context that is relevant for understanding them (Giorgi 1966).

Tracing the various roots of constructivism represents a set of traditions, each of which contains its own historical origins and associated schools, often overlapping in methods and generating variant traditions over time. This is natural for an approach that promotes methodological flexibility. However, constructivist research traditions share a great deal. They reject traditional non-reflective positivist approaches to knowledge and assert that studies of the human experience are not approachable through reductionist, context-stripping quantitative methods. Researchers who embrace a constructivist perspective consider the whole experience rather than only segments of an experience. Instead of seeking to measure occurrences, qualitative researchers search for the essence of meaning they obtain through first-person accounts in narratives, informal or formal conversations, or observations of people within a particular cultural context (Moustakas 1994). In some traditions, they may also discover meaning in artifacts, such as poems, pictures, or stories that enrich their understanding.

A central focus of qualitative inquiry is how people construct meaning in a social, personal, and relational world that is complex and layered. For qualitative researchers, the objective is always to do justice to the experiences of their informants, whom they often view as coresearchers, by opening up meanings in areas of social lives not easily understood (McLeod 2001). Qualitative research emphasizes learning about phenomena inductively and in their own right; it addresses open, exploratory questions and seeks to discover unique phenomena (Elliott 2008).

Critical to establishing the connection between diversity practice in relational therapy and the constructivist paradigm is the view that our understanding that people’s experiences are historic and culturally relative. “Not only are they specific to particular cultures and periods of history, they are seen as products of that culture and history and are dependent upon the particular social and economic arrangements prevailing in that culture at that time” (Burr 2003, p. 4). These approaches produce more textured knowledge and reveal subjugated and indigenous meaning as they attempt to distance knowledge production from the control of elite groups (Kincheloe 2008) who claim they have expert knowledge.

Overview of the Traditions of Qualitative Research

Efforts to categorize the traditions of qualitative research are widespread and vary. They represent an evolving set “methods” that often involve refinement, transformation, or reconfiguration by a new generation of adherents to the original “tradition.” There is also considerable overlap in methods, although the language associated with each tradition may be different (Creswell et al. 2007).

In order to draw on various elements for the Bricolage, I discuss qualitative research traditions often referred to in the social work literature or employed in studies of clinical practice. These are ethnography, phenomenology and hermeneutics, heuristics, and grounded theory. I will briefly review the history, characteristics, and conceptual elements associated with each of these traditions; I will also suggest how each can enhance diversity practice in relational therapy. Ultimately, I will construct a tentative toolbox for the clinician that draws on these principles. Although all constructivist research traditions call on the same ontological values, each offers different elements that may be relevant for promoting diversity in relational therapy with different clients and under different circumstances.

Ethnography

Overview. Ethnography is the earliest distinctive qualitative research tradition; it strives to understand the culture of a group of people. It involves study within social settings, where the researcher has the opportunity for emersion in that locale and access to both direct observation and interactions with particular social groups. An underlying assumption of ethnography is that when a group of people interacts together, they will evolve a culture, which is a set of patterns and beliefs that guide the members of the group. Participant observation in the tradition of anthropology is the primary method used in ethnographic study (Patton 2001). Typically, ethnographers keep extensive field notes to record their observations and interactions, generally accompanied by separate analytic notations. The purpose of ethnographic inquiry is to produce a representation of the cultural or social group studied (Tedlock 2000).

Jovanovic (2011) and others (Denzin and Lincoln 2004; Patton 2001) locate the historical origins of modern qualitative study within ethnography. The earliest practitioners of this method worked during the beginning of the last century with anthropological field investigations of different cultural groups. These early ethnographers included Bronislaw Malinowski, Gregory Bateson, and Margaret Meade. They believed they had the authority as researchers to represent the experiences of the people they studied, a situation that dissolved over time with the changing ontology of qualitative inquiry (Denzin and Lincoln 2003). However, early ethnographic studies took place among remote, nonliterate cultures, and anthropologists could become enmeshed in issues of Western colonialism by either trying to sustain a culture’s distinctiveness or to act in the service of imperialism (Patton 2001).

By the 1930s, ethnography solidified around long-term fieldwork through participant observation of a particular group, which became associated with the Chicago School of Sociology (McLeod 2001). However, as ethnography developed, researchers recognized its potential for understanding more proximate cultural groups; it also trended towards revealing the processes of hidden or subjugated populations. The luminaries of this approach were Robert Park and W.H. Whyte, and Whyte’s ethnographic study, Street Corner Society, remains a classic example of the method of participant observation, where the researcher spends time with people, listening to them, observing their interactions, and maintaining field notes. In this tradition, current ethnographic studies coalesced around modern social problems. In the case of organizational ethnographic study, these methods can also illuminate the culture of institutions.

Applications for Diversity Practice. Ethnographic study involves long periods of intimate study and a keen awareness of the stages of fieldwork, because the relationship of the ethnographer to the object of study changes over time, and the stance of the observer must be open to discovering the experiences of people they observe. In participant observation today, the researcher looks for feedback to verify their observations; in addition, direct observation allows for understanding how the context shapes cultural expectations. Ethnography enables researchers to include their own perspectives through direct observation of an experience. These conceptual features mirror the processes whereby therapists can learn about the distinctive cultural features of their clients over time.

Both the historic objectives of ethnography to learn about other cultures and the methodological evolution of participant observation methods are signal elements for a Bricolage of diversity practice. Although participant observation of a cultural group is generally not available to clinicians, its underlying assumptions underscore important perspectives for diversity practice. Examination of other cultures on their own terms provides the practitioner important guideposts. These include direct observation over time, where the researcher must be open to the experiences of the people they observe and the incorporation of their own experiences as reflections of their observations (Finlay and Evans 2009). For the clinician, these elements lay the groundwork to respect the unique aspects of specific groups, the important role that context plays in the development of cultural expression, and how both emersion and self-reflection can lead to fresh discoveries in the therapeutic interaction.

Phenomenology and Hermeneutics

Overview. Phenomenology originated in work of Husserl who saw it as a way to understand and describe phenomena as they reveal themselves to people’s consciousness through meaningful lived experiences. Husserl was a prolific writer who left over 45,000 pages of manuscript, some of which remain unstudied (McLeod 2001). Nonetheless, Husserl’s work has led to several interpretations of his ideas on phenomenological methods that focus on how researchers and subjects jointly construct meaning. Overall, the purpose of phenomenology is to understand the world from the subject’s point of view and discover the world as a subject experiences it (Kvale 1996). In order to do this, the focus is on how to put together experiences that make sense of the world. Consequently, phenomenology rejects the idea of a separate objective reality. Instead, it is a search for the experiential essence (Patton 2001).

Among the most prominent groups developing a research approach based on Husserl’s principles is the Duquesne school of empirical phenomenology, where the methods for achieving meaning-making and the subjective interpretations involved in understanding are central (Giorgi 1966, 2005; Moustakas 1994; McLeod 2001). These include four processes that enable the researcher to understand the meaning and fundamental nature of an experience. They include, Epoche, phenomenological reduction, imaginative variation, and synthesis (McLeod 2001; Moustakas 1994).

The concept of Epoche originated with Husserl and involved freeing oneself from all suppositions. In Greek, Epoche means to stay away from or to abstain. This prepares researchers to receive knowledge by allowing new events, people, and experiences to enter into their consciousness (Moustakas 1994). Carrying out Epoche requires putting aside anything that would obstruct a fresh vision and establish an original vantage point without authoritarian views of the world promulgated by society’s experts. In this way, researchers can understand phenomena as they present themselves (Moustakas 1994). Notably, for Moustakas, the challenge of achieving Epoche is not only to clear mental space to enable researchers to be open to external experiences but also to “be transparent to ourselves” (p. 86) through a process of meditative reflection. The researcher strives to develop an attitude of openness and wonderment about the phenomenon under study (1994).

If Epoche describes the mental preparation of the researcher, phenomenological reduction describes the initial observational processes themselves, which involve an iterative process of looking and describing. This is a way of both seeing and listening to experiences in their own right; this ultimately enables the researcher to grasp fully the nature of a phenomenon. It also involves bracketing off anything except what the researcher has learned about the phenomenon. It follows the principle of horizontality, which requires the researcher to consider all meanings as equal and not to privilege any one. Only later can the researcher eliminate irrelevant, redundant, or overlapping observations, leaving the “horizons” or meanings and constituents of the phenomenon (Moustakas 1994).

The next step in this process is imaginative variation, where the researcher’s task is to utilize imagination to see the experience from various frames of reference and develop thematic material from the phenomenological reduction process. There is no single truth; instead, countless possibilities unite the observations. This leads to various descriptions of the phenomenon into a synthesis of meaning. Notably, there is no unique synthesis of a phenomenon, and the essence of an experience is never exhausted. This is because the observations the researcher makes have taken place at a particular point in time and from a personal vantage point. Moustakas (1994) summarizes this process as follows: “One learns to see naively and freshly again, to value conscious experience, to respect the evidence of one’s senses and to move toward an inter-subjective knowing of things, people, and everyday experiences” (p. 101).

Hermeneutics grew out of the analysis of written texts, and narrative analysis expanded the idea of what constitutes a text for study to include a broader range of materials as primary sources of research data. These include oral histories, life narratives, creative writing, and transcriptions of in-depth interviews. The concept of a story or a personal narrative enables the researcher to become a part of the cultural experience of the storyteller, and culture threads throughout discussions of discursive forms of qualitative analysis. Clearly, stories and narratives offer windows into social meanings that may not otherwise be available (Patton 2001). This approach focuses on how people use stories to communicate their experiences to others (McLeod 2001) and of particular interest is how they can inform a researcher about the ways in which people make sense of their experiences. This highlights the similarity between narrative analysis and phenomenology (McLeod 2001).

From McLeod’s (2001) perspective, the two basic epistemological approaches that engage the researcher in the search for meaning are phenomenology and hermeneutics. On the surface, they appear to take opposite tacks; phenomenology is a meditative process that involves the researcher indwelling in the phenomenon until its essence is revealed. In hermeneutics, understanding always begins from a perspective imbedded in a significant cultural text. The assertion is that the research can never be entirely free of preconceptions because we ourselves inhabit our own cultural universe. Consequently, hermeneutics forces researchers to go beyond their “culture-based understandings” (McLeod, p. 56) and allows the inquiry to develop from emersion in the experiences of the other. Phenomenology does not place knowledge within a social or historical moment, whereas hermeneutics sets the topic of inquiry within a set of contextual features (McLeod 2001).

Nonetheless, both traditions assume an active construction of a social world by people and deal primarily with language or artifacts, such as pictures or physical objects that represent phenomena. Heidegger is the philosopher most associated with bringing together phenomenology and hermeneutics. Heidegger had been Husserl’s assistant and was familiar with hermeneutics from his theological studies. He promoted the “natural attitude” of the researcher, which contrasted with phenomenological principles such as Epoche or bracketing, which involved the suspension of any preconceptions. Instead, the “natural attitude” provided the researcher with an interpretive horizon through which to understand phenomena. Although Heidegger’s support for the Nazi party and failure to recognize the Holocaust has interfered with his influence, his importance for qualitative researchers was his appropriation and integration of ideas from both phenomenology and hermeneutics. If hermeneutics can only speak to what people have already assumed to exist, phenomenology opens up the possibility of revealing something entirely new. He recognized that as soon as we begin posing questions, we were making assumptions about an experience. Consequently, the examination of what guided the researcher to those questions requires understanding and exploration. For McLeod (2001), both aspects are necessary to study the experiences of everyday life.

Applications for Diversity Practice. Elements of both the methods and the underlying perspectives of phenomenology and hermeneutics are useful. For relational therapists, the actors in developing understanding include the experiences of both the client and the therapist and how language is a vehicle for revealing hidden and implicit meanings in the everyday world of each. In the clinical encounter, therapists must free themselves of suppositions in order to allow the client’s life experiences to emerge. In the language of phenomenology, this occurs through Epoche and bracketing; both encourage therapists to focus entirely on the cultural meanings clients ascribe to their life experiences. At the same time, Heidegger recognized that it is impossible for people to rid themselves entirely of their preconceptions. Following Moustakas, this calls on the therapist to be transparent about their own cultural beliefs and ideas about people with diverse life experiences. Taken together, the concepts of Epoche and bracketing from phenomenology and the natural attitude from hermeneutics position the clinician to take in the unique perspectives of patients; at the same time, they remain aware of their own cultural proclivities and existing ideas about those of others. Simultaneously remaining aware of these two perspectives potentiates the relational aspect of the therapeutic encounter.

An important contribution of hermeneutics for the diversity-aware clinician is its origins in the meaning of cultural artifacts that represent the broad experience of a particular group. Reflecting on both Hartman’s examples, texts written by Black Americans, women, homosexuals, immigrants, and people with mental illness are one source to expand the natural horizon of the clinician. Diaries, pictures, and descriptions of festivals and ceremonies are vehicles that enable clients to interpret their meaning for the clinician. Similarly, storytelling provides windows into cultural dimensions not otherwise available to the therapist.

Heuristic Inquiry

Heuristics is singularly associated with Clark Moustakas, who sought a word that would capture the essence of his personal investigations of the human experience. He found that term in the Greek word, heuriskein, to discover or find, a word he describes as a “cousin word” of eureka (Moustakas 1990, p. 9) in recognition that these discoveries lead researchers to new meanings about the human experience. Heuristic inquiry begins with a problem the researcher seeks to answer that represents a personal challenge to their understanding of the world. In this sense, it is autobiographical; however, it must have a universal social significance.

Researchers have employed Moustakas’s principles of heuristic inquiry (1990) to study psychotherapy, including the effects of the therapist’s characteristics on their practice (Stephenson and Loewenthal 2006). These studies rest on qualitative research findings founded on heuristic principles of “the internal search to know” (Nuttall 2006). The heuristic model strives to plumb the depth of others of all ethnic and cultural groups. Similar to other qualitative traditions, heuristics includes “observations” of a range of cultural artifacts. This calls for reflexivity, a concept familiar to qualitative researchers as an active questioning process that requires researchers constantly to reflect on their own assumptions (Lit and Shek 2002).

Moustakas (1990) proposed concepts that guide this process, beginning with identification of the focus of inquiry and becoming one with it. Ultimately, through self-dialogue, the researcher allows the phenomenon to speak to and question it. Through this iterative process of self-dialogue, multiple meanings emerge, which eventually coalesce into core meanings. This process requires openness, receptivity, and attunement to all of the experiences the researcher has with the phenomenon. It also requires honesty about one’s own experience in relation to the question or problem. Throughout heuristic research, tacit knowing enables the researcher to see beneath the explicit perceptions of the world around us. Intuition links implicit knowledge and explicit knowledge that is easily observed and described, because it allows the researcher to utilize an internal capacity to make inferences and arrive at knowledge of underlying dynamics. Logic and reasoning are not at play; instead “we perceive something, observe it, and look and look again and again from clue to clue until we surmise the truth” (p. 23). Finally, indwelling is the process of turning inward to gain a deeper understanding of an aspect of the human experience. It is conscious and deliberate and allows the researcher to follow clues that lead to fundamental insights about the experiences of interest (Moustakas 1990; Douglas and Moustakas 1985).

Applications for Diversity Practice. Moustakas was unique among qualitative research scholars because he explicitly applied a research approach to clinical practice. His book Heuristics (1990) has specific sections on its application to psychotherapy and person-centered therapy. He asserted these methods could guide clinicians to put aside their received beliefs and superior roles to discover the truth of a client’s ethnic and cultural experience as the client experienced them. The objective was for clients to develop and reveal a portrayal of personal significance they themselves ascribed to their cultural groups. Subsequently, others (Finlay and Evans 2009) have written about its therapeutic applications, but few (Anis 2005; Freeman and Couchonnal 2006) have applied these or similar principles as a means to bridge cultural and racial differences between therapists and their clients.

Heuristics offers the Bricolage unique channels for clinicians in their pursuit of connectedness and relationships with clients. The process of heuristic inquiry includes emersion, involving self-search and self-reflection; acquisition, which discloses experiential meanings; and, finally, realization, resulting a synthesis of the true nature of experience (Moustakas 1990). More significantly, the processes of this method, self-dialogue, tacit knowing, intuition, and indwelling, offer the clinician guides for linking their own inner dialogue with strategies to reveal the cultural features of their client’s life experiences. Elements from heuristic methods can apply to practitioners who embrace relational theory as they seek to understand their client’s highly individual representations of cultural, ethnic, and religious traditions. However, perhaps the most salient feature of heuristics for relational therapists in their search for diversity practice is the degree to which this tradition relies on the depth of understanding required of researchers about themselves. After all, the driver of inquiry is a personal challenge both the researcher and the clinician must experience.

Grounded Theory and Constructivist Grounded Theory

Although some have described grounded theory as the “default” qualitative research approach (Drisko 2008, Personal communication) or the “market leader” in qualitative research (McLeod 2001, p. 70), in actuality it lays out very specific procedures for a specific purpose. Even though numerous and varied qualitative studies claim grounded theory as their methodology, it began as an explicit attempt to formalize an inductive research process using prescribed analytic methods to develop empirically grounded theories; in this tradition, the goal of qualitative methods is inductive theory development (Flick 2002). Some assert that the popularity of this approach rests in its explicit focus and methodology, which suggests the potential for replication. In other words, the specificity of data collection and analytic procedures has made it more acceptable as a model of inquiry because it involves a systematic approach that implies rigor (McLeod 2001; Patton 2001).

Barney Glazer and Anselm Strauss, two scholars from the University of Chicago Department of Sociology, originally laid out the principles of this approach in The Discovery of Grounded Theory (1967). In this book, they proposed a specific method for researchers to follow, beginning with the conceptualization of the problem under investigation through a highly technical and detailed approach to data collection, analysis, and reporting. In this tradition, the relationship between the researcher and the informants is relatively unexplored; instead, grounded theory focuses on the emersion of the researcher in the data. It is primarily a set of principles for data collection and data analysis, generally done alone (McLeod 2001). Elements unique to grounded theory include indentifying a broad, action-oriented open-ended question for inquiry.

The researcher approaches the problem under investigation with an open mind, so that themes will surface from the data without any preconceptions. In other words, by not culling theoretical possibilities in advance, the researcher can remain neutral and allow the data to drive theory development. Data collection and analysis take place simultaneously, so that concepts identified in earlier observations inform those the researcher subsequently explores. Data collection ends with saturation, which occurs when researchers determine they will not gain any further ideas from subsequent observations (McLeod 2001; Moustakas 1994).

Over time, grounded theory methods have been refined in subsequent work by Strauss and Corbin (1990). Recently, Charmaz (2006) took a more flexible approach in what she describes as “constructivist grounded theory,” which she contrasts with “objectivist grounded theory.” She calls for a more interactive and emergent approach and elevates the significance of the meaning and actions in the lives of the subjects. In addition to emphasizing the individual’s view, values, beliefs, and ideologies, her work promotes a more active role for the researcher than earlier expositions of the method. In other words, she stresses the interpretive traditions of qualitative research in her application of the principles of grounded theory.

Through careful analysis of the data that involves examination of field notes, detailed study of transcribed interviews, coding of each element, sorting of codes, and constantly comparing those codes, the researcher ultimately constructs a theory about the issue studied (Moustakas 1994). The key to grounded theory is the emersion of the researcher in the data and strict adherence to a purely inductive process, in other words, the production of theories from observations in the real world. Grounded theory involves unraveling the elements of an experience toward the development of a mid-level theory. The purpose of these theories is to propose a way of understanding about the nature and meaning of phenomena. Each study has its own detailed sequences of continuous questioning of gaps, omissions, and inconsistencies that the researcher identifies. Similar to other qualitative traditions, context and structure play important roles in an inductive proof where the researcher is continuously proposing theories and checking them against observational data (Moustakas 1990), in the case of clinical practice, what transpires in that relationship.

Applications for Diversity Practice. Certain elements of grounded theory and constructivist grounded theory have the potential to “ground” the relational clinician in practice with diverse populations. Continuously tuning into gaps, omissions, and inconsistencies in client’s stories leaves room for the clinician to explore areas that clients do not easily reveal about cultural practices or differences they have with the practitioner based on ethnic norms. Charmaz’s emphasis on the researcher’s and the subject’s views, values, beliefs, and ideologies also brings this method closer to an element of diversity practice. It suggests that clinicians must enter the therapeutic relationship with willingness for self-exploration. The suggestion that researchers should not come to the research process with theories – what Patton (2001) would call sensitizing concepts – may also be useful in certain circumstances. If therapists have their own strongly held “theories” about particular groups, they must learn to recognize what they are and “test” them in relation to the particular client with whom they are engaged. However, the central lesson of grounded theory for clinicians is its fidelity to induction. In other words, it suggests that what clinicians come to understand about a client’s cultural identification comes directly from clients themselves and therapists’ interactions with them. Within this approach is respect for the unique cultural representation of the individual client.

Bricolage: Methods from Constructivist Research for Relational Therapy

Kinocheloe (2001, 2005) provides a rich conceptualization of the Bricolage, which has important implications for multi-method and multidisciplinary research. In his vision, the bricoleur exists within the complexity of the real world, and his task is to “uncover the invisible artifacts of power and culture and [document] the nature of their influence not only on their own scholarship but also scholarship in general” (Kincheloe 2005, p. 324). However, others (Warne and McAndres 2009) envision an even wider application of the Bricolage, which draws parallels between the research and therapy. “[Any] research setting is imbued with both conscious and unconscious meaning processes and meaning. This is significant both in the generation of research/practice data and construction of the research/practice environment” (p. 857). Finlay and Evans (2009) make an explicit link between qualitative research and relational therapy using the metaphor of a “voyage of discovery” (p. 3). This chapter blended these concepts to provide relational therapists with an approach to diversity practice that drew on constructivist approaches, recognizing similarities between these research concepts and clinical practice.

Ethnography, grounded theory, phenomenology, and heuristics are only some of the historic and expanding array of constructivist research traditions. Their growth and integration over time has been an informal form of the Bricolage (Denzin and Lincoln 2003). It is apparent in examining the development of various qualitative traditions that scholars have adapted and expanded elements of existing models or joined models and proposed them as variations of a particular tradition. Heidegger reframed the phenomenological concept of Epoche as the “natural attitude” when he sought to create a clearing in which the ordinary aspects of life could be revealed. The ultimate result was an integration of phenomenology and hermeneutics (McLeod 2001). Similarly, Charmaz altered grounded theory to “constructivist grounded theory,” another example of the mutability of these traditions that address changes in the application of research methods over time.

Although it would be possible to draw from an even larger array of qualitative research traditions, methodological elements of the traditions presented here provide a starting point to guide diversity practice for relational therapy. Typical of the constructivist enterprise, some of these concepts appear in more than one tradition or are implicitly threaded throughout. For example, in every case, these traditions involve induction. The researcher makes meaning based on observations rather than on preexisting theories. However, the strategies involved in ensuring that the researcher’s own “theories” about the world do not interrupt a vigorous inductive process vary. For example, in grounded theory, the researcher achieves induction by careful coding procedures that put the brakes on his or her own predilections. In contrast, the concept of Epoche, which endures throughout phenomenology and existential phenomenology, requires specific mental preparation on the part of the researcher to eliminate any preconceptions. However, in both cases, the objective remains the same – to allow the worldview of the client to emerge (Table 1).

Table 1 Bricolage for diversity practice in relational therapy: principles from constructivist research methods

As the earliest qualitative method, ethnography recognized that groups of people that interact together develop a distinctive culture that expresses itself in the relationships among members, sets of beliefs about the world, behaviors that the group endorses or rejects, and other characteristics that reinforce norms and modes of expression. Cultural distinctiveness was at the heart of their studies. In their practice, ethnographers recognized they could best understand the cultural features of a group by emersion in that culture and long periods of in situ observation. Although it is not feasible for clinicians, or for that matter many researchers, to engage in participant observation studies, the signal legacy of ethnography is its emphasis on the unique aspects of a culture and its influence on individual’s expectations about themselves and other members of the group. This suggests that clinicians should be open to the experiences their clients report and incorporate their own experiences as they reflect on both. Field notes are a metaphor for this process in therapy. Just as the ethnographer records observations in the field, the clinician maintains a mental log of how clients construct meaning in their lives; just as the ethnographer records their own responses to their observations, the clinician examines their own responses to the client’s worldview. Ethnographic study has always involved observations over time and the researcher’s own reflections on those observations. In therapy, both emersion and self-reflection can promote discovery in the therapeutic interaction.

The intertwining traditions of phenomenology and hermeneutics utilize written and narrative language as vehicles for revealing the explicit and implicit meanings in the everyday experiences of both clients and therapists. In this respect, a major contribution of hermeneutics is investigation of the cultural artifacts that represent the unique experience of a group. These include diaries, religious texts, or descriptions of festivals or ceremonies that can become vehicles for clients to interpret their meaning for therapists. Similarly, storytelling is an important vehicle where therapists can learn about how clients construct meaning that would otherwise be unavailable to them.

From the perspective of phenomenology, therapists need to rid themselves of any preconceptions they have about a client, in order to focus entirely on the cultural meanings each client ascribes to their life experiences. Presumably, this occurs in a preparatory phase through Epoche or the conscious act of eliminating all preexisting assumptions about the client’s primary reference group. Subsequently, as the client begins to reveal cultural constructions to the therapist, bracketing keeps that content separate from the clinician’s own perspectives. Although this may be possible in unique circumstances, where the therapist is completely naïve about the client’s cultural past, it is unlikely to occur among either researchers or highly educated clinical practitioners. Heidegger’s “natural attitude” recognizes that these preconceptions are a part of the human experience. Consequently, this calls for therapists to be transparent to both their own cultural beliefs and open to those of their clients. They need to remain simultaneously aware of their own cultural proclivities and existing ideas about those of others in order to potentiate the relational aspect of the therapeutic encounter.

In their original conception of grounded theory, Glazer and Strauss also called on researchers to the inquiry without any preexisting theories, since their approach was entirely inductive and all theories developed from the data. Although qualitative methods rely almost exclusively on inductive as opposed to deductive logic, grounded theory is perhaps the strongest tradition for promoting induction and for establishing a method to ensure that it occurs. Simply put, theoretical propositions were grounded in the data. This is a useful posture for the clinician, and it represents another strategy for eliminating preconceptions about the cultural context as the client experiences it.

Another feature of grounded theory that is useful for the relational therapist is located in methods that occur during data collection or during a therapeutic interview. Therapists should continuously tune into gaps, omissions, and inconsistencies in client’s stories. When this occurs, the clinician should meticulously explore those areas. They may indicate regions where clients do not easily reveal information about cultural practices or differences they have with the ethnic norms they attribute to the practitioner. Charmaz’s emphasis on the researcher’s and the subject’s views, values, beliefs, and ideologies also brings this method closer to an element of diversity practice. It suggests that clinicians must enter the therapeutic relationship with willingness for self-exploration.

Heuristics is unique because its sole adherent, Moustakas, specifically applied heuristic methods to clinical practice in psychotherapy and person-centered therapy. In these chapters, he determined that these methods could help practitioners put their received beliefs and superior beliefs aside to uncover the true ethnic and cultural experiences as clients experiences them. Related to his autobiographical approach to qualitative inquiry, it was important for clients to develop a portrait of themselves imbedded in their cultural groups, which will lead to the truth about the client’s ethnic and cultural experience as they experience them. The objective was for clients to develop and reveal a portrayal of personal significance they themselves ascribed to their cultural groups. Subsequently others (Finlay and Evans 2009) have written about the applications of qualitative methods to therapy, but few (Anis 2005; Freeman and Couchonnal 2006) have applied these or similar principles as a means to bridge cultural and racial differences between therapists and their clients.

However, perhaps the most salient feature of heuristics for relational therapists as they strengthen diversity practice is how it relies on the depth of understanding required of researchers about themselves. After all, the driver of inquiry is a personal challenge the researcher and the clinician must experience. Consequently, methods such as self-dialogue, tacit knowing, intuition, and indwelling offer the clinician guides for linking their own inner dialogue with strategies to reveal the cultural features of their client’s life experiences.

Reservations and Rewards of Joining Research and Therapeutic Concepts

Clearly, the purpose of conducting a research study is different from conducting a therapeutic interview, and not all elements of any research paradigm are relevant for relational therapy or any psychotherapeutic model. However, in an exploration of humanistic psychology and qualitative research, common principles emerge, such as individual uniqueness, the dominance of the client’s perspective, the essence of interpersonal connection, and flexibility of approach (Patton 1990; Soldz 1996). Nonetheless, the purpose and function of these two ventures are very different (Patton 1990). The meaning for clinicians is the therapeutic effects of the interview, while qualitative researchers seek a larger canvas to explore problems and present them in a scholarly forum. The application of the Bricolage in the intimate relationship between client and therapist is a much smaller canvas. It is meant to provide tools for probing the unique aspects that both the social worker and the client bring to the engagement.

Some have already explored the application of qualitative methods to promote cultural competence and rejected it. Williams (2006) analyzed how various constructivist epistemological paradigms could guide social workers achieve cultural competence; this was an original research-driven approach to the problem of multicultural education and practice. Another reservation here is the increasing interest in critical racial theory that some social work educators are using to guide diversity education and could conceivably apply to individual practice. Critical racial theory rests beneath the larger paradigm of critical theory, itself a research paradigm in Denzin and Lincoln’s (2003) elegant typology. The ontological perspective of critical theory is that social, political, cultural, and economic forces shape reality. In addition, ethnical, gender, and racial values crystallize over time. Critical theory is closely aligned with a postmodern worldview, and it is imbedded in the notion that structural forces shape life experiences. Recently, some social work educators (Abrams and Moto 2007; Ortiz and Jani 2010) have proposed ways in which to apply critical race theory to augment diversity practice; this also has the potential to advance diversity practice through creative application of various constructivist concepts. Besides the implications of hanging diversity education squarely on race to the exclusion of gender, nationality, sexual identity, religious affiliation or any of the other ways in which social workers must transcend difference in their practice, an intrinsic feature of this paradigm is that it pulls the discussion towards macro issues in social work practice. For the clinician who employs a relation-centered approach, the issues are closer to the bone.

Study Questions

• 1. Why should relational therapists be concerned about their authority in relation to the clients they serve? What are the factors that nourish the power of clinicians in their engagements with clients?

• 2. What do you consider the ideal relationship between knowledge about a client’s cultural, ethnic, religious group or group affiliation, and what a clinician can learn in their interactions with individual patients?

• 3. Do you consider it possible to achieve Epoche in initial sessions with clients? Are there other components of the Bricolage that you believe would be more productive in “letting in” the experiences of clients?

• 4. Imagine that you have a second-generation South Asian young man who has come to you with symptoms of depression. His immigrant father is no longer able work in his small business, so your client has left college and taken over responsibility for running the store. In his home country, young men normally take responsibility for the family in such circumstances. He was a promising engineering student but had to leave school. Why would it be important to understand the cultural context in both the home country and the US in working with this patient?