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

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 therapeutic exchange we can note another related Gap. This is the Gap that arises in the attempt to apply propositional knowledge by creating and utilising processual knowledge.

Today two therapeutic approaches exist with regard to same-sex sexual desire. The first is in support of the gay coming out process, and second adheres to the virtue of changing sexual orientation. In and of themselves these perspectives have no fault, but they take on different value and purposes in different contexts. Either perspective may be detrimental or beneficial depending on its application in the client's particular political context. In other words, both perspectives can be abused by trying to fit the client into the worldview the therapist thinks is best for the client.

Of course any therapist worth her salt will not read her client in terms of her own worldview. However, slippage does occur whereby the therapist understands the client according to her own worldview. Furthermore no therapist can or should completely immerse herself within the other's worldview. After all, that would be against the very process of psychotherapy whereby a therapist utilises her position as (empathic) outsider to bring the patient from one position in relation to the world to another. It is in this balance of being both inside and outside the client's worldview that the therapist is able to provide assistance. Alas, biased slippage may occur whereby the client is read too much in terms of the therapist's own worldview.

At this point we need to qualify what is understood by worldview. In a therapeutic paradigm, "the world" is a constructed understanding of systems of human interactions structured and hierarchised by power. Each person holds an individual representation of these systems. Within these systems people act out of the system's requirements as well as from their own impulses and wills. Examples of systems of interaction would be institutions (families, schools, police, judicial system, health care systems) or any perceived set of meaningful exchanges between people that are sustained for enough time to be perceived of as a unit operating according to certain rules and towards certain ends. These ends are not merely pragmatic but also political i.e. sustain certain patterns of privilege and domination. The perception of systems is both idiosyncratic and shared. The definition of "worldview" thus encompasses the therapist's professional (shared) and `personal' (idiosyncratic) interpretation or understanding of the world or its systems of interactions.

A professional interpretation (shared academic worldview) would be one guided by a particular psychological paradigm such as psychodynamic, humanist, cognitive-behaviourist, and is better referred to as the therapist's propositional knowledge. A `personal' interpretation (idiosyncratic worldview) is guided by applying propositional knowledge and personal experience, common sense, intuition or `gut feel' to the fluidity of presenting situations. This definition thus states that processual knowledge is not knowledge separate from propositional knowledge, but is knowledge generated by the trial and error of applying propositional knowledge. Yet processual knowledge would not be very specific but rather constitute a generalised `feel' or an habituated sense of recognition of the applicability of a certain propositional knowledge to a situation. What also makes it `personal' is that it brings to bear the therapist's value system upon her application of propositional knowledge. The therapist's values influence her understandings and responses especially. But values are not only part of the therapist's personal worldview and particular to her processual knowledge. The therapist's values also have a social or political origin within a social and professional community. It is through processual knowledge that the personal confidential nature of therapy becomes infused with public values and political positions.

Given the above definitions a therapist cannot act using purely propositional knowledge. The evidence for `personal' perspectives infiltrating the `professional' stance lies within the fact that therapists often adhere to different paradigms of therapy based on personal preference. Another reason why personal views influence professional ones is because personal experience is required to bring professional knowledge to life. The application of abstracted propositional (professional) knowledge to the idiosyncrasy of the client requires a processual (personal) knowledge on the part of the therapist.

Tappan and Brown (1992) argue that interpretation occurs within a hermeneutic circle in which two impulses move the interpretation:

1) the impulse to understand the true or intended meaning of the `text' or the narrative of the other i.e. drawing on the empirical fact.

2) the impulse to construct or understand the meaning of a text guided by the assumptions and values of an interpretative community.

The second point refers us to the fact that no interpretation is made outside of a political and value-laden context. Every professional comes from some or other community that holds certain values dear, and will selectively advance certain narratives of morality and `truth'.

Interpretation is the dialectical tension between the two mentioned impulses. The first impulse can be rephrased as the therapist's attempt to recognise actuality as it is mirrored by her propositional knowledge, and the second impulse is the attempt to connect with or understand the coherent story or narrative of the client via the therapist's processual knowledge. By applying propositional knowledge the therapist is imposing an intuitive "sense of..." (processual) knowledge onto the client's narrative in order to create a synthesised understanding of the issue at hand. This "sense of...", the way the matter fits together, is slanted towards the therapist's worldview by the values that she holds. Tappan and Brown argue that this dialectic is a paradoxical interpretative circle. To understand a text as it actually is, in its own terms, one is required to connect with it. To connect is to utilise one's biased processual knowledge to make narrative sense out of it. But, in order to make the connection, one must understand the text, to identify its propositions, as it actually or factually is. It is within this ebb and flow of connection and accurate perception that the Gap in pragmatic knowledge arises.

The paradox exists because of the values that colour one's processual knowledge. Where our theoretical knowledge Gap revealed the difficulties in resolving interpretations around ontological principles, the Gap in processual knowledge is created by the difficulties in separating out epistemological from moral or value principles. The application of propositional knowledge for pragmatic effect inevitably embellishes propositional knowledge with values. The Gap in processual knowledge lies in the fact that the application of propositional knowledge always occurs in favour of, or from the perspective of, a person immersed within a scientific and social community that holds certain values. No interpretation of fact can be made separate from assigning it a value within our stratified worlds. The dilemma arising from this is, "Do we assign values to accurately perceived facts, or do our values construe the appearances of facts in particular ways?" The Gap is not knowing the cutting line between fact and value. The Gap is our uncertainty, our possibility of making an error or being correct without knowing which is which. This uncertainty is taken from the relativity and variety of values or moralities.

The Modernist Means of Dealing with Knowledge Gaps

We are suggesting that the application of objective propositional knowledge requires some subjective appraisal. Knowledge employed in the therapeutic situation requires an unavoidable blend of objective and subjective knowledge. Modernist concerns vouching for legitimate objective truth refer to this subjective component as the professional's expertise, which serves to ameliorate or lessen the emphasis on the professional's subjectivity and cloak it in an aura of objectivity. As in the case of theory, this move to smooth over the effect of subjectivity as a means whereby the Gap between subjective (processual) and objective (propositional) knowledge is denied.

There are times when we can't say that one value is better than another and the matter is one of belief. Value affects the interpretation of fact or the application of fact and thus makes understanding out to be relative. As an example: We may say that it is a fact that same-sex desire exists. Our value perspective dictates whether it is acceptable and should be encouraged, or is an abomination and should be discouraged. Owing to the lack of absolute truth about same-sex desire, values inform the way in which one will draw on the facts or perception of actuality and apply them in understanding people as either in need of cure or reaffirmation. By disclaiming the influence of values the "expert" will assert one of these positions as being factual and unproblematic and in the client's best interests.

But this example is based on a gross dichotomisation. The therapist/expert's disclaimed subjective bias may happen more subtly. Let us illustrate this with the example of a person who enters therapy because of her discomfort with having same-sex sexual desires. The therapist will apply her propositional knowledge about what form the underlying distress may take and what the goal of psychotherapy should be. This knowledge will include empirical findings about the origin of homosexuality and the possibility for change. It may also include knowledge about research done on the importance of accepting one's sexual orientation or changing it. Via the therapist's processual knowledge, this potpourie of empirical research findings are applied in accordance with the goal that the client may have for herself, i.e. to change or accept herself. This client-focused approach is more likely to be the approach of choice in today's politically correct climate. Given this assumed unproblematic attunement between the therapist's propositional knowledge and the client's requirements it would be modernistically claimed that a co-constructivist understanding has been reached! Alas, it is assumed that no subjective appraisal has been made by the therapist that reflects her own bias and that an objective attunement with the client is the modus operandi.

Alas, let us take the case of a therapist even who honestly seeks to help a client accept her homosexual desire a part of her identity. The therapist will lie somewhere on a continuum of internalised homophobia that she may be aware of to a greater or lesser degree. However, the ethic of professionalism maintains that the therapist will be able to dissociate herself from these personal values. A therapist may not overtly voice her opinion yet the therapist's sentiments (in/out of awareness) will affect her "sense of..." or intuitive responses used to understand the client's worldview and to construct a new worldview that will allow betterment. Although a therapist may genuinely wish to assist a gay client in coming out, she may unwittingly convey her discomforts by avoiding certain topics or fail to give certain reaffirmations (because of her own morality) and which may seem like disapprovals of the client. Various authors have cited the occurrence of such unwitting bias (Murray 1956, Greenson 1967 and Truax 1966 cited in Eagle 1984).

Within the context of same-sex desires, it is not topical to construe the issue in terms of sex. The move to no longer construe homosexuality as a perversion has instilled the asexualisation of homosexuality in the therapeutic encounter. Same-sex desire difficulties are often sterilised into concerns with identity and the experience of rejection. Therapeutic silences and ignorance about gay sex may greatly distort the therapeutic message. On the other hand, silences may also occur when the therapist fails to create space for the possibility that the client may have same-sex desires. The therapist thereby fails to facilitate or even suggest to the client the possibility of exploring such an option and may unwittingly prolong the closeted person's distress (Wooley 1992). Of course the opposite may happen as well in which the emancipatorily focused therapist's conviction that the client is gay obscures possibilities for exploring bisexuality or even legitimising the choice of heterosexuality.

These silences are made possible by not overtly acknowledging the Gaps in theoretical and processual knowledge. Theoretically the therapist cannot know to what extent the client should be viewed as determined by her personal and social forces to be gay. Neither can the therapist know fully to what extent the client has the capacity for free choice about sexual orientation. Does the road to health require enabling the client to follow her culture's prescriptions, her `innate dispositions' or facilitating her sense of choice? Processually the therapist must weave together an understanding of the client given what she propositionally knows about the client's wishes, desires, hopes, fears, family and social background. The therapist's personal capacity or processual knowledge used to do so is influenced by her value system and creates a Gap in absolute objectivity. Within these theoretical and processual Gaps the therapeutic uncertainty arises and the possibility exists that the therapist encourages or discourages same-sex desires where she should not.

Given the gap in knowledge we can have no answers with certainty and it is within the Gap that the second source of political influence is introduced. What constructs a person lies far beyond the immediacy of the therapeutic relationship. A person does not enter therapy with all their facets intact that are potentially analysable or discernable. Political forces of oppression and struggles of contestation occur in the varied domains of the client's private self, the home, the workplace etc. The therapeutic space forms one of the many spaces whose influence is not necessarily able to impact on the other spheres of one's life. Therapy cannot undo environmental pressures and deprivation, an assertion which is self-evident and certainly not new. The problem lies not with this state of things but with the potential bias of therapy towards anarchy or conservativism as a result of the concealment of the Gap in knowledges. It is this denial that opens therapy up to exploit people or manipulate them to its own ideological ends. In order for therapy to be non-exploitative it would have to own up to and put up for question its own political stance.

Making Use of the Gap

Eagle (1984:168) confronts the Gap in knowing opened up by the paradox of the interpretative circle. He proposes that a certain type of interpretation is required, namely "good enough interpretation". This may be defined as an interpretation that is 1) in accordance with what is generally known about a problem (i.e. as espoused by inference and empirical testing), 2) that does not conflict with what we deem human nature, and 3) is conveyed with authentic concern.

First this definition tries to convey the importance of utilising empirical facts within interpretations, noting the importance of ascertaining some realist correspondence between interpretation and reality as best as we can. But given the Gap in propositional knowledge, something more is required.

To address this matter Eagle notes that any claim to truth must be considered within its assumptions about human nature. Assumptions of human nature are not factual assertions but rather moral espousals of what should be human nature. They are ontological assumptions shaped by values. Here Eagle may be referring to the use of processual knowledge, the means whereby static empirical ideas are brought to life within a political context within which certain values dominate certain scientific and social communities. Psychological knowledge is thus implicated within a political project. This project is about the contestation around what ought to be and who has the resources to command the most influence in determining that. Psychological knowledge is situated within and unavoidable articulates with or against different political projects through the values that are held by the discipline as well as the therapist. Although this is easy enough to admit, Eagle requires us to acknowledge it and bring it into the therapeutic relationship. In this way we come to confront the Gap in our propositional knowledge by confronting its situatedness within values. Alas we are still faced with the Gap in processual knowledge, that is, the inability of the therapist to fully understand the other owing to the paradox of the interpretative circle. The therapist is still trying to understand the client from her position of power, value and empirical knowledge. In that way she is still ego-centric and her limitations lie within the Gaps that occur within her self-based abilities to access propositional and processual knowledge. What is missing from this equation is the Other, the client as an active part of the therapeutic relationship, with her own form of knowledge that may be legitimately different from the client.

Thirdly Eagle's definition emphasises caring. This points to the fact that psychological interpretative knowledge is not abstract but embedded within a relationship. The relationality of the knowledge further points to the political implication of that knowledge, that is, if one were to agree that relationships are not preprogrammed interactions running off set empirical instructions, but are rather the result of a negotiation within the context of inequalities. That means that it is through the means of the relationship that empirical knowledge and political value are unavoidably transmitted as interlaced and negotiated between the two parties. The nature and quality of that relationship will thus affect the way in which values and knowledge are transmitted and negotiated. It is the very relationship that shapes the particular mixing of politics and empiricism, value and fact. Through the relationship a knowledge unique to that relationship is established that is a product of both the therapist and the client's worldviews. Eagle refers us to `caring' as being the best form of relationship with which to relate to and involve the client to ensure effective understanding. Thus to deal with the Gaps in interpretative knowledge the relationship is epistemologically essential. This means that since relationality is two-way and involves negotiation of what is to be regarded as knowledge, the epistemology of therapy requires co-constructivist knowledge.

Yet what is a caring relationship? How is one to conduct the therapeutic exchange that is sensitive to the political inequalities within which it exists? Phrased epistemologically, how can the caring relationship involve the client in creating knowledge without imposing a biased understanding?

Modernistically, the caring relationship has involved a concern with countertransference and a denial of the Gaps in the therapist's understanding.

The Modernist Caring Relationship

The modernist solution to preventing the therapist from introducing the bias of her subjective values is for the therapist to control, carefully scrutinise and reservedly employ her subjective responses to the client. In Psychoanalytic literature this is referred to as the concern with countertransference. For the purpose of this paper countertransference shall be considered to include the wide range of subjective responses any therapist may have to her client. By subjectivity is meant the therapist's value laden responses emanating from her own worldview as opposed to responses based on processual knowledge concerned with understanding the client's worldview. Various therapists may employ these reactions differently, but common to all disciplines is that there are limits to which that subjectivity may be used and that careful professional constraints should be placed on it to prevent outright bias or unethicality.

This concern with `countertransference' is comparable to Social Anthropology's concern with the effects of its own ethnocentrism in its interpretive work of other cultures. Moore (1988) contends that preoccupation with ethnocentrism is a way of covering up racism, i.e. a way of talking about the Other that prevents them from talking about themselves. Ethnocentrism maintains western preoccupations as the position from which to interpret the Other, the problem is to try and reduce the biased influence of that position so as to understand the Other better. It is part of a modernist discourse that our task is to rule out significant bias, in our understandings, in order to reach a validated Truth. This worry with reducing a lack of understanding renders one object in terms of another and merely accounts for the bias introduced in doing so. The concern with ethnocentrism is thereby a means of talking about the Self through a preoccupation with the Other.

Countertransference worries are attempts to reduce our bias or lack of understanding of the Other. Our beliefs about what it is that is to be understood is not put to question. That this should be so is rooted within a tradition of science that considers its own beliefs to be more valid and true (according to its paradigmatic rules) than other beliefs. Countertransference in this context is a hinderance to understanding the patient by means of scientific models of the psyche. Countertransference is seen to hinder the better or scientifically more true interpretation of the client.

But this preoccupation with the therapist's subjective bias tries to override the inevitability of the Gaps in therapeutic and processual knowledge. It tries to adjust for bias in order to nullify those Gaps and therewith the uncertainty in knowledge about the client. Concerns with countertransference may thus be an indication of the extent to which the therapist has subtly and unwittingly embedded herself within her own preoccupation with understanding the patient in a particular way. This preoccupation has subtly appropriated the client into the therapist's value system and worldview. To treat countertransference as a hinderance to understanding the Other denies the fact that it arose as a response to an unavoidable lack of understanding in the first place, that is not so much a result of the therapist's lack of personal resolution or the client's "projective identification", but because of the epistemological unavoidability of Gaps in understanding.

The question now becomes, "Do we need to wait for the recognition of the bias of countertransference before we can realise the limits of our knowledge, prevent its domineering imposition, and guide our activities of caring?" If yes, then we have an especially weak tool that is reactive rather than proactive. We are thus missing what it is about our way of relating, about the denial of epistemological Gaps, that makes us stumble into countertransference! As argued above, it is the arrogance of science to understand regardless of the Gaps within theory and practice, that preoccupies it with countertransferences. But what principle allows the denial of knowledge Gaps?

This principle is the typical modernist assumption that observation does not influence the object's true significance, and that the object's significance existed prior to observation (Kulick 1995). Observation and theory building thus assumes a particular form of value as inherent in the object. This enables the therapist to omit her own subjectivity, to deny her lack and therefore reassert her unequivocal legitimacy.

What is particularly omitted is that a particular value-laden motive brings the observer to view the object in a particular way or brings the observer to regard the object at all. This motive cannot be as a result of the universal value of the object, since none exists. Rather it betrays a particular form of interest in the object, which informs the observations made and theory constructed.

Through the presence of value in knowledge, the subjectivity of the therapist becomes as much an issue in the therapeutic relationship as the client's subjectivity is. The acknowledgement of propositional knowledge's embeddedness in values highlights the paradox of the interpretative circle and calls upon the judicious use and not restraint of the therapist's subjectivity in constructing knowledge about the client.

The modernist approach to the caring relationship is thus shown to situate us back within a blissful innocent denial of the Gaps in knowledge. We are still faced with the problem of how to create co-constructivist knowledge without biasing knowledge towards the therapist's frame of reference. How do we acknowledge the Gaps in processual knowledge and accommodate that lack within the epistemology of therapy? The answer may lie in how we manage the subjectivity of the therapist. Apart from modernist defensiveness, is there any other way in which to confront the limitations of the therapist's subjectivity?

The Self-Reflexive Caring Relationship

The answer may lie in the virtue of reflexivity. Reflexivity is a means whereby we investigate how we came to be or know ourselves and our world in the way we have, and for whom and to what effect we arrived at this knowledge? (Kulick 1995). Reflexivity requires the exposition of the therapist's understanding of herself as a prerequisite to the understanding of the Other. Kulick (1995) cites Dwyer (1982) saying that to expose the self is to question the self's effort and the social systems that give that effort its force. For the therapist it is "an epistemological questioning of how it is that I (the therapist) am speaking" (Kulick 1995:16). This is a similar form of questioning to the therapist's questioning of how it is that the client is speaking in ways that reflect her symptomatology or distress. This questioning is of the historical and political and personal conditions that allow the therapist to speak, as well as limit and structure her interactions with the client (Kulick 1995). In other words, the therapist is drawn to relativise and question her discipline's and her personal knowledge and values.

The limits of being able to understand become clear reflexively, which exacts the risk of getting involved or immersing oneself in another's worldview (Kulick 1995:15). This allows the concept of your Self to be challenged in a deconstructive moment whereby the Self and the Other are no longer dichotomously opposed. Kulick warns us that this entails more than just inserting the self into the narrative of the other which would be merely using the other as a way of talking about the self. Instead it is a surrendering of all that is familiar to oneself in the willingness to concede that other value systems are equally legitimate even if opposed to one's own. Vulnerability and risking disintegration of the familiar should be engaged in by the therapist as much as it is required of the client. Empathising in this context means more than inserting oneself within another's worldview. It especially involves owning the fragility and anxiety associated with the client's experience of being situated on the margins of normality, health and dominant knowledge/narrative.

Reflexivity compels the subjectivity of the therapist to acknowledge the self as not only being an autonomous independent unity maintaining continuity, coherence and integrity, but also a fluid politically situated discursive arrangement (Kulick 1995:16). This distinction may be understood by distinguishing between reflexivity and reflecting. Reflecting is to gaze upon the Self as a self-contained monadic unit. It is a self-analysis that isolates the Self from the other, effectively only considering or relating to the Other in so far as the Other resonates with or says something about the Self (i.e. countertransference as an ethnocentric problem). Reflexivity is to note how the Self is a more permeable entity interdependend with other selves and creates or effects the image of the Other. Reflexivity shows up how our assumptions of what we think is the case and should be the case are projected onto others. We take account of others' subjectivity via our own. In consequence, knowledge of the Other is thus partial to the extent that it is an unavoidable projection. This is to say that no pure access to the objective Gapless truth about the Reality of the Other is possible. Our interaction with the Other inserts us within the Other, so that understanding the Other requires an understanding of ourselves and our motivations bringing us to relate to the Other in the way we have chosen to.

To therapeutically know the Other means noting the limits imposed by our political value perspectives as well as the limits of our propositional knowledge. These limits make apparent the boundaries of our persons and our worlds. These limits denote the extent to which our boundaries of knowing are unable to encompass the Other. An option still open to us is to perforate our boundaries and allow the Other to enter us. This means that the therapist needs to allow herself to entertain the thought of being different, to awaken possibilities within herself that she may not have realised were there e.g. for a heterosexual therapist to entertain the possibility of being homosexual or visa versa. In this way the boundaries of the therapist become fluid and open to being challenged by the Other's difference in ways that may even initiate change within the therapist. To fully empathise with another would not only be through understanding the Other's worldview, but by understanding how the limits of your self-definition precludes you from reaching a full understanding of the other. By reflexivity the therapist becomes willing to undermine her interpretative power and surrender some of that power to the client. This willingness however must not be passive but an active invitation to the patient to disagree and challenge the therapist's interpretations. To communicate that limitation and to invite disagreement is to promote the agency of the client in co-constructing knowledge. Co-constructionist knowledge is the product of both the therapist's propositional and processual knowledge as well as the client's knowledge of self and world, both of which make a contribution to understanding that are legitimate in their own right.

Acknowledging the limitations or partialness of the therapist's knowledge allows the client to realise the partial constructedness of the world. Agency is born at this moment when the client realises her own and her therapist's constructedness in discourse. The client's agency stands to make a choice about which constructions to defy and which to adhere to. However, the question remains, "What will the client base her choices on if there is no objective archimedean point of certainty from which to do so?". In the modernist paradigm the client draws on much of the therapist's strength, holding and reflecting and uses this experience of security and the interpretations or reflections of the therapist as means to consolidate the self into a new position of `health'.

This view advocates the therapist as a source of consistency, continuity and support for a client who has none by virtue of her distress. It is assumed that a client in such a state of vulnerability requires the illusion of security offered by the therapist and is too weak to sustain the reality of the therapist's limitations. The client is said to need to idealise the therapist and receiving a delusional reassurance. Clearly many clients may have the need to start off in this frame of being and may gradually only be able to accept the therapist's relativism. However this view constructs therapy as a succession of phases from which is a modernist fiction. The process of therapy is far more intermeshed by various moments of resistance to and questioning of the therapist. Resistances occur from the first moments of therapy. Because of knowledge Gaps it cannot be unilaterally declared that resistances early in therapy undoubtedly express a maintenance of the symptoms, whilst only resistances later in the course of therapy, may be acknowledged as legitimate knowledge counter to the therapist's. Instead the therapist must entertain and explore the potential validity of the resistance no matter when it occurs, by engaging in self-questioning. Exploring these resistances is imperative to creating a new co-constructionist knowledge and being true to a caring relationship.

What remains unanswered is what the client draws on, to make choices, if it is not the therapist's illusive stability. What the client draws on is her agency which is born out of the knowledge of the constructedness of the world. Discourse is the medium upon which the client's agency may draw. Yet, discourses operate within material constraints. Agency thus involves making choices whereby the client draws on discourses that may sustain her material bodily experience better than other discourses and so provide her health. The point at which she employs new discourses is the point at which a person has become convinced that that discourse will be more suited. This point of conviction is motivated by a reason for change, a reason which is found in the realisation of one's own and other's partial constructedness i.e. that I do not totally have to be the way I have come to understand myself to be.

To have conviction in one's self or to have self-assuredness is an experience of who one is and the context in which one is so. It reflects an awareness of the place you occupy relative to others and how different discourses may be drawn on to help you move within the web of interpersonal interactions. Conviction is the state from which you speak with resistance as well as being open to accommodate and assimilate differences into your sense of self. If the client's conviction in herself is a necessary outcome of therapy then we also need acknowledge that we are encouraging the client to be different and resistant, even questioning of our own positions. Providing another with the tools of conviction is to have given them an insight into the ways people build up discursive arguments to justify themselves, and that this process involves drawing on a community of people who support one's own value position and realising how the relativity of value influences the constructions of fact.

Freud (1920) stated that in therapy it is important for the client to acquire "the convictions that make him independent of the physician's authority" (p.377). For Freud this was supposed to occur after resistances to one's inner truth have been overcome. But in

Freud's case study on female homosexuality it is evident that he meant that resistances to the therapist's interpretations had to be overcome. His client stated she attempted suicide because of her experience of rejection at the hand of her father, her lover and underlying that text is rejection from society as well. But Freud believed that his client's suicide fitted into a picture of her unconscious strategy to take revenge on her father for impregnating her mother and being hateful towards her mother as rival for the father. Alas the client merely responded to these insights as "very interesting" (p.390) without allowing them to affectually influence her. Freud saw this as resistance to her Oedipal truth, consequently pathologising her same-sex desire, despite having said in the beginning of the study that she was without neurosis. What he fails to note is how this resistance may have come from a source of strong conviction in her same-sex desires. In this case the client was bereft of any access to gay liberatory discourses and access to a community with pro-gay values that would have allowed her to counter-construct herself in defense. Within a self-reflexive position Freud could have come to realise how her resistances indicated experiences that lay beyond his own self-construction. Aiding the client in this context would have meant encouraging the client to play with different construels of herself and the world. Thereby she could start experiencing herself as agentively moving in her world and not being moved. Suicide would not need to be an option any more, but more positive ways of being gay (or bisexual) could be explored.

The matter is not that Freud was right or wrong, but that therapy involves moments of resistance that call on the therapist to admit to the Gaps in her knowledge and work with the client to build a legitimising discourse around the client's sense of conviction. The client's agency thus draws upon what she thinks will be best for herself, although that choice is also informed by the client's exposure to the therapist's interpretative knowledge. The point here is not that the therapist's knowledge is redundant and that what really matters is the client's agency and free will. Instead, the issue is for the therapist to encourage agency subsequent to having imparted her knowledge, based on the premise that the therapist's knowledge is limited. The hallmark is that neither party pretends to know the real answer although each is willing to try a variety of possibilities of understanding, each one involving the risk of deconstructing one's own familiarity about oneself.

Empowerment is to allow and enable the patient to become an agent with a critical voice, who can struggle not only internally within herself, but also externally in negotiating her way within the expectations of society.

Some Last Words

Therapy tries to change a person who has to go back into a world that has not changed together with her, she has to go back and face the same old problematic relationships she has always been situated within. What makes the therapeutic relationship unique is that the therapist as person provides an experience of being understood that few people are able to or willing to give a person. The self-reflexivity engaged in by the therapist is a unique experience that is not easily paralleled in everyday relations. Therapy is thus a ritual space in which the client is faced with possibilities of experiencing herself and new ways of relating that may not easily exist within the real world as it is known to the client. The caring therapeutic relationship is instead one in which the client is given the unique experience of relating to someone who may be challenged, yet who will remain connected in the aid of co-establishing a working solution or insight for the client's predicament. The client thereby experiences a way of relating and of experiencing herself within a context of questioned inequality and constructedness.

The aim of therapy is not to bind the client to the therapist but to ultimately enable the client to agentively approximate a sense of conviction enough to extricate her from the old relations that constrained and constructed her, and then to reposition herself with purpose and will within new relations, or to realise a capacity to work at effecting those new relations.


Foucault, M. (1977) Discipline and Punish: The birth of the prison, Allen Lane, London

Freud, S. (1920) "The Psychogenesis of a Case of Homosexuality in a Woman" in The Penguin Freud Library Vol 9 pp367-400

Hanly, C. (1992) The Problem of Truth in Applied Psychoanalysis, Guilford Press, New York

Kirby, K.M. (1996) Indifferent Boundaries: Spatial Concepts of Human Subjectivity, Guilford Press, New York

Kulick, D. (1995) Eagle, M.N. (1984) Recent Developments in Psychoanalysis: a critical evaluation, McGraw-Hill, London

Masson, J. (1992) Against Therapy, Harper Collins, London

Moore, H.L. (1988) Feminism and Anthropology, Polity Press, Cambridge

Rogers, C.R. (1951) Client Centred Therapy Constable, London

Tappan, M.B. and Brown, L.M. (1992) "Hermeneutics and Developmental Psychology: Toward an Ethic of Interpretation" in W.M. Kurtines, M. Azmitia and J.L. Gewritz (eds) The Role of Values in Psychology and Human Development, John Wiley & Sons, NY.

Wooley, G. (1992) "Beware the Well-Intentioned Therapist" in R.Simon, C.Barrileaux, M.S. Wylie, L.M. Markowitz (eds) The Evolving Therapist: Ten Years of the Family Therapy Networker, The Guildford Press: N.Y.

Anthony Theuninck is an honours student in Applied Psychology (1997). He will be completing his Masters in Research (by dissertation) entitled "The Extreme Stress Experience of having Homosexual Desire in a Homophobic Society" in 1998. This work aims to draw on ideas of complex PTSD (DESNOS). Any person interested in this field may feel free to contact him.

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
critical methods society - -