Emptying the constructed self
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Emptying the constructed self:
Integrating mindfulness, awareness, acceptance and constructivist psychotherapy
Spencer A. McWilliams
Constructivist approaches to psychotherapy enjoy continuing and growing
interest. Kelly (1955) introduced personal construct psychotherapy (PCT) more than fifty
years ago, and recent volumes on constructivist psychotherapies (Mahoney, 2003;
Neimeyer, 2009; Raskin & Bridges, 2008; Winter & Viney, 2005) and the increase in
therapists employing constructivist epistemology (Neimeyer, Lee, Aksoy-Toska, &
Phillip, 2008) demonstrate its continuing relevance and active elaboration. Similarly,
while Suzuki, Fromm, and DeMartino (1960) and Watts (1961) drew attention to the
relationship between Buddhism and Western psychotherapy nearly fifty years ago, recent
authors have elaborated the use of Buddhist concepts, and practices such as mindfulness,
awareness, and acceptance, in Western psychotherapy (Epstein, 2007; Hick & Bien,
2008; Kaklauskas, Himanheminda, Hoffman, & Jack, 2008; Kwee, Gergen, &
Koshikawa, 2006; Magid, 2002; Segall, 2003; Watson, 1998).
Kelly (1955) viewed PCT as technically eclectic, and his constructivist followers
join productively in dialogue with, and appropriate techniques from, a variety of
perspectives (Neimeyer & Neimeyer, 2002). Neimeyer (1988, 1993, 2009) labeled this
process “Theoretically Progressive Integrationism,” in which approaches that share
compatible metatheoretical assumptions provide a basis for explaining the value and
relevance of particular interventions (Feixas & Botella, 2004; Raskin, 2007; Walker &
Winter, 2007). Constructivism and Buddhism share fundamentally similar
metatheoretical assumptions (Kwee, et al., 2006; McWilliams, 2009; in press), providing
an opportunity for furthering the progressive theoretical integration of constructivist
psychotherapies by examining Buddhist-inspired psychotherapeutic methods that
enhance the client’s mindfulness, awareness and acceptance.
This chapter: 1) summarizes some fundamental constructivist assumptions and
approaches to dysfunction and psychotherapy, along with parallel assumptions and
approaches in Buddhist-inspired psychology; 2) demonstrates that these approaches share
substantially similar metatheoretical assumptions and compatible views of human
dissatisfaction and dysfunction, 3) describes therapeutic approaches that exemplify the
incorporation of mindfulness, awareness, and acceptance practices, and 4) discusses the
relevance of these methods for constructivist psychotherapy and theoretically progressive
integration. Constructivist and Buddhist assumptions agree that we cannot justify any
belief as ultimately ‘true.’ Both view knowledge as evolving interdependently within
personal and social contexts, and described in conventional, rather than ultimate,
language. Thus, rather than proposing ‘the’ definitive explanation of these topics as an
inherently absolute account, the article presents one perspective that inevitably reflects
the author’s personal experience and understanding.
Constructivist Perspectives
Metatheory
Foundationalism historically proposed that we can know a mind-independent
‘world as it is’ and that people possess cognitive capacities for accessing that world. This
agenda has failed because we have never identified a way to grasp a mind-independent
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reality, shown that we can know the ‘world as it is,’ or proven what ‘representations’ of
the world actually represent (Rockmore, 2004; Rorty, 1982). Rockmore (2005) promotes
constructivism as the best successor to failed foundationalism, suggesting that humans
only know what humans construct, constrained by human limitations.
Rather than viewing knowledge as discovered or revealed, constructivism
suggests that we invent it, as interpretations of experience, embedded in historical
contexts, dependent on human activity, and revisable rather than fixed. A variety of
perspectives relevant to constructivist psychotherapy share this viewpoint (Chiari &
Nuzzo, 1996; Raskin, 2002), including Personal Construct Psychology (Fransella, 2003;
Walker & Winter, 2007), radical constructivism (Glasersfeld, 1995), contextualism
(Hayes, Hayes, Reese, & Sarbin, 1993; Sarbin, 1976), social constructionism (Gergen,
1999), and postmodern psychology (Gergen, 2001; Safran & Messer, 1997), although
their differing emphases merit recognition and respect (Paris & Epting, 2004; Raskin,
2008; Raskin, Weihs, & Morano, 2005).
Constructivism views the universe as integral, interconnected, and interrelated; in
continuous change or flux; and lacking inherent nature or essence (Stojnov & Butt,
2002). Humans, collectively and personally, impose structure and assign meaning to
phenomena based on human needs and experience. Ideas, explanations, and beliefs
evolve within a context and a perspective, and reflect changing contexts and conventions
rather than ‘the way the world is.’ Humans use language to reflect on experience, make
meaning, and cope with life. We cannot know reality directly; we describe experience in
a variety of ways with no objective way of justifying beliefs as ultimately true. Rather
than concern about the ‘truth’ of beliefs, we judge them by pragmatic criteria: their
usefulness in predicting events, their coherence, and their fit with subsequent experience.
Human Dysfunction & Well-Being
Constructivist perspectives view psychological dysfunction as occurring when the
system of meaning that a person creates for organizing and understanding experience
creates obstacles to meeting personal goals and considering viable alternative ways of
thinking, behaving, and making meaning. Kelly (1955), for example, defined a
psychological disorder as “a personal construction which is used repeatedly in spite of
consistent invalidation” (p. 831). Psychological well-being transpires when identities
and interpretations lead to effective anticipation of events and the ability to revise
interpretations in light of their effectiveness.
Psychotherapy
When meanings that people create to understand and guide their lives fail to aid
effective life negotiation, constructive approaches to psychotherapy help clients examine
and reconsider these understandings. Therapists challenge existing constructions and
assist clients in reconstructing their ‘life story,’ inventing new self identities, and
experimenting with alternative, more effective ways of meaning making (Bridges &
Raskin, 2008). G. Neimeyer (1995) describes “three central features of constructivist
therapy: the primacy of personal experience, the importance of novel enactments, and the
role of ‘languaging’ in developing new patterns of personal meaning” (p. 112). He views
clients’ problems as reflecting their construction system and encourages exploration and
elaboration of new meanings. R. Neimeyer (1995, 2009) describes characteristic
constructivist therapy strategies such as assessing clients by exploring their personal
narratives and life metaphors, promoting personal development and meaning making
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rather than correction, accepting negative emotions as a normal component of change,
emphasizing the individual’s sense of self and core structures, empathically engaging in
the client’s outlook, and viewing resistance as a reasonable protection of the client’s
meaning-making system. Bridges & Raskin (2008) emphasize constructivist
psychotherapy as a meaning-based practice concerned with the reality of the client’s
experience, and they discuss examples of five clinical strategies or models of
constructivist psychotherapies: encouraging clients to adopt new behaviors, bringing
unconscious knowledge into conscious awareness, assisting clients with retelling their
personal stories, connecting clients’ stories with their behavior, and viewing clients’
problems in terms of language and social and cultural factors.
Buddhist Perspectives
Many intriguing parallels exist between constructivist and Buddhist approaches to
knowledge and psychology, although the term ‘Buddhism’ does not encompass a single
set of concepts or teachings. Buddhist concepts most relevant to constructivism and
psychotherapy and most frequently articulated by Western psychotherapists typically
reflect esoteric, transformative (Wilber, 1983) teachings from Asian monasteries as
brought to the West, and as interpreted in a contemporary context (McMahan, 2008).
Metatheory
The Middle Way, or Mādhyamika, School (Garfield, 1995; Luetchford, 2002;
McWilliams, 2009; Streng, 1967) serves as a philosophical and metatheoretical
foundation for much of Buddhism and provides an epistemology intriguingly similar to
constructivist views. It describes phenomenal experience in terms of three
characteristics: dependent origination, impermanence, and emptiness. Dependent
origination means that ‘things’ depend on other ‘things’ for their identity. Composites
consist of parts, gain identity only as an assembly of parts, and lose that identity when
taken apart. Identifying and acknowledging ‘things’ requires the process of human
perception and labeling. As a result of interdependence, we cannot identify intrinsic
entities that maintain their identities independently across time (Garfield, 1995). The
concept of impermanence proposes that no phenomenon has always existed in its current
state or will always exist in that state or with those qualities. Phenomena come into
existence when conditions supporting their existence occur, and when those conditions no
longer transpire the phenomena no longer exist. Emptiness, or lack of essence, proposes
that since phenomena exist only in interdependence on other phenomena and constantly
change, we cannot identify an essence or identity that exists independently and that
constitutes the entity itself, nor can we isolate a substance that gives a phenomenon
identity independent of its attributes. Ultimately, if we attempt to analyze the identity of
phenomena, we cannot find something to point to as the thing itself.
From this perspective, ‘no thing’ exists on its own. As Garfield (1995) put it,
focus on particular phenomena “depends more on our explanatory interests and language
than on joints nature presents to us” (p. 113). Consistent with an epistemological
constructivist view (Chiari & Nuzzo, 1996), the world and the phenomena we experience
exist. However, since an entity does not possess its own independent, permanent,
identity, any proposition suggesting that we know ‘ultimate truth’ proves incoherent.
Although we cannot make assertions about ultimate reality, we can know
conventional and relative reality and ‘truth,’ following ordinary human assertions as
dependent on social convention. The historical Buddha encouraged his students to go
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along with conventional beliefs and perspectives that prove useful and deny views that
people in general would reject as incoherent. Based on experiences and customary ways
of understanding and speaking about them, we may regard ‘things’ relatively, and view
‘thing’ as a description rather than an entity (Watts, 1961). Conventional truth, as with
constructivist perspectives, consists of ideas and beliefs that humans have developed,
collectively and individually, by identifying recurrent patterns and themes in experience
and using them to anticipate future events. Similarly to Kelly’s (1955) description of the
construing process, we perceive similarities and differences, repeated themes and
patterns, and invent word labels to describe the poles of the contrast dimensions.
Contrasting poles arise together and depend on each other. For example, ‘good vs. bad,’
‘light vs. dark,’ and ‘up vs. down’ describe ‘empty’ phenomena that do not possess these
qualities inherently and depend on human assessment for their existence.
Glasersfeld (1995) pointed out that we cannot create just any reality we wish.
Since we desire a viable understanding that effectively serves human functions,
environmental, biological, and social realities constrain it. Buddhist philosophy agrees
that our conventions reflect biological, psychological, and social needs, as well as
customs and language. Within these constraints, we can identify facts regarding what
words mean and how to agree on empirical observations, but we cannot identify an
independent viewpoint from which to justify these views as absolute (Garfield, 1995).
Self
Constructivist approaches view ‘self’ as a social and personal construction rather
than an independently existing entity. Buddhist psychology applies the concepts of
interdependence, impermanence, and emptiness to ‘person’ and ‘self’ (McWilliams,
2000, 2004a). It views a person as a composite of five parts, elements, or attributes:
physical body, sensations, perceptions and cognitions, predispositions and volitions, and
consciousness. Each ‘component’ arises in interdependent relationship with other
phenomena, and they evolve and change from moment to moment and over the course of
a human life. Thus, similar to social constructionism (Gergen, 1999; Raskin, 2002), we
can find nothing to point to as the ‘person’ or a ‘self’ independent of the ever-changing
body, sensations, and thoughts. We believe, however, that components must have a
location, an inherent self, where they occur. We construct a sense of self and give it an
illusory reality by appropriating experiences of physical sensations, perceptions, and
volitions as possessions. We need not posit the existence of a self independent of our
perceptions and actions in order to act as ‘ourselves’ in socially conventional ways.
Human Dysfunction & Well-Being
Viewing phenomena as dependent, impermanent, and empty and speaking about a
conventional, constructed reality have practical purposes. Psychological problems arise
by confusing empty conventional reality with inherent, ultimate reality, and treating
conventional beliefs and concepts as ultimately ‘true.’ We reify concepts like self,
objects we perceive, and values and beliefs because we believe that without a real self,
world, and values, life would have no meaning and would appear hopeless (Garfield,
1995). However, reifying constructed interpretations leads to delusion. Suffering and
dissatisfaction accompany attempts to impose permanence and independent essence on
the flow of experience, and believing that ‘things’ actually exist. Clinging to reified
concepts as a means of creating hope and meaning actively subverts this intention. A
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reified world in which events, phenomena, and things exist permanently, independently,
and with a fixed essence provides no hope for change, progress, or human agency.
But if instead we treat ourselves, others, and our values as empty, there is hope
and a purpose to life. For then, in the context of impermanence and dependence,
human action and knowledge make sense… It is only in the context of ultimate
nonexistence that actual existence makes any sense at all (Garfield, 1995, p. 318).
The historical Buddha articulated the foundation of human dysfunction and
dissatisfaction by enumerating Four Noble Truths: 1) Life involves suffering, frustration,
or dissatisfaction. 2) Suffering results from craving, attachment, or clinging to our desire
that life suit our expectations. 3) Relief of suffering results from letting go of clinging,
desire, and attachment to phenomena, which always change. 4) Certain disciplines and
methods can assist us in the process of ridding ourselves of clinging.
Frustration arises when we do not fulfill our desires and strivings and when we
are faced with experiences that we do not want (Hayes, 2003). We try to reduce
frustration by attempting to force the universe to conform to our desires. However, the
universe does not bend to individual will. Adjusting desires and expectations to fit actual
experience and reducing attachment to wishes and aversive labels of events results in a
mentality open to possibilities and alternatives, and adaptable to change. Wallace and
Shapiro (2006) describe a Buddhist view of psychological well-being in terms of mental
balance among four interconnected components: conative (intention, volition, and goals),
attentional (sustained mindful, voluntary, attention), cognitive (engaging with experience
as it arises moment-by-moment without preconception) and affective (emotional
regulation such as equanimity and lack of vacillation, apathy, or inappropriate emotion).
Meditation, Mindfulness, Awareness, and Acceptance
Cultivating awareness of the present moment, and the process of creating self and
identity, helps overcome dissatisfaction and achieve well-being. By loosening
identification with social roles we can see them as a ‘game’ with rules based on social
convention rather than as the nature of the universe. Understanding emptiness and the
conventional nature of reality requires moment-to-moment awareness of how we reify
constructs and treat empty phenomena as real. Meditation techniques cultivate awareness
of thoughts and experiencing the emptiness of phenomena, with the goal of liberation
from dogmatic clinging to reified concepts, including self (McWilliams, 2003, 2004b).
In contrast to inventing more effective ‘worldviews,’ meditation practices focus
awareness on the process of creating a worldview, observing how we circumvent
experiencing the present moment through beliefs and a sense of existence as independent
selves. The sense of a separate self begins to fall away through the practice of observing
thoughts and bodily sensations. From a perspective of ‘no self,’ meaning derives from
immediate physical experience and awareness rather than from a constructed narrative.
Beck (1989, 1993) describes Zen meditation practice as paying attention to the
totality of the experience of the moment. Although sounding easy, it requires disciplined
practice because we do not always experience the present as pleasant. We filter
experience in terms of likes and dislikes, and imagine a future that fulfills our desires and
expectations. Meditation practice shifts attention from ‘spinning’ in a mental world to
‘right-here-now’ awareness of physical sensations and thoughts. Comfort in life derives
from living ‘right-here-now’ experience whether or not we like it.
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Many Buddhist practitioners have found four methods particularly useful
(McWilliams, 2000). Focusing or concentration techniques such as following the breath
help settle and quiet the mind and develop mental discipline. This provides a foundation
for practice, but by itself tends to close out awareness of the wider world of experience.
Observing and labeling thoughts help gain familiarity with favored thoughts, opinions,
and beliefs and ultimately weaken and interrupt identification with them. Experiencing
bodily sensations (sounds, touch, tensions) helps develop awareness of the physical
reality of the present moment, which constitutes the only life ‘reality.’ Noting emotional
reactivity, by attending to physical responses to pleasant or unpleasant experiences, helps
develop awareness of reactions to events, reducing the strength of these reactions.
To summarize, a Buddhist perspective, consistent with constructivist perspectives,
proposes that we can never have ultimate knowledge of phenomena, including self, due
to their interdependent, impermanent, empty nature. We can describe phenomena in
conventional terms that assist in daily living. Reification of identities and roles and
clinging to desires and beliefs creates suffering and dissatisfaction. Well-being evolves
from declining attachment to ideas, beliefs, and self-centered desires, observing thoughts
rather than believing them, embracing and accepting the present experience, whether it
suits us or not, and acknowledging thoughts regarding the experience.
Psychotherapy
Attending to the process of thinking and feeling, rather than focusing on the
content of thoughts and feelings and treating them as real, provides a crucial method for
overcoming self-centered attachment. Psychotherapists incorporating Buddhism in
psychotherapy, (Anderson, 2005; Epstein, 2007; Magid, 2002; Rubin, 1996; Segall, 2003;
Watson, 1998) emphasize process over content. Observing thoughts allows experiences
without either clinging to them or trying to change them, and facilitates seeing through
the delusion of a fixed self. Psychotherapists using Buddhist practices typically use
techniques such as awareness of breath and sensations, observing feelings, and other
experiential meditation techniques (Mohan, 2003; Rothaupt and Morgan, 2007). Khong
describes mindfulness practice that encourages clients to “label, acknowledge,
experience, and let go of their experiences” (2003a p. 48), cultivate direct experience and
attention to thoughts and sensations as they arise (2003b), and stressing the difference
between modifying mental content and awareness of the mind’s processes (2006).
Many Buddhist-inspired therapists strongly suggest that in order to teach
awareness and mindfulness methods to clients appropriately and effectively,
psychotherapists should adopt a disciplined meditation practice of their own (Hick &
Bien, 2008), preferably under the tutelage of a recognized teacher. Grepmair et al. (2007)
found that Zen mindfulness practice enhanced psychotherapists’ effectiveness. Segal, et
al., (2002) initially intended to simply add mindfulness based methods to their preexisting approach to cognitive therapy, wishing to improve their ability to ‘fix’ clients’
problems. However, they found that the approach evolved from a ‘fixing’ orientation to
solving a problem to helping clients experience the problem, welcoming and allowing
thoughts and feelings, experienced as bodily sensations, without reacting to them.
Initially regarding mindfulness practice as another therapeutic technique, they came to
adopt their own mindfulness practice as essential in the change from their roles as a
therapists or ‘fixers’ to their roles as instructors in mindfulness.
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Representative Psychotherapeutic Approaches
Those interested in pursuing the integration of constructivist and Buddhist
perspectives might benefit from examples of well-elaborated therapy approaches
emphasizing awareness, mindfulness, acceptance, and reducing attachments to thoughts
and emotions. The following therapeutic models address these themes.
Experiential Personal Construct Therapy
Awareness of the present moment includes bodily experiences as well as the
experience of thoughts and beliefs. Experiential Personal Construct Therapy (Leitner &
Faidley, 2008; Leitner & Thomas, 2003) elaborates the PCT approach by incorporating
non-cognitive aspects, including embodiment. Based on the assumption of an integral
universe, the arbitrary division between mind and body unnecessarily restricts the utility
of psychotherapy. Personal meanings impact bodily systems, and psychological
meaning-making processes manifest in the physiological experience of bodily sensations
and events. Core construing develops prior to language, and the ability to trust bodily
experiences, through confirmation and disconfirmation, evolves along with the
development of pre-verbal constructs. As a verbalized meaning system develops,
initially sensed bodily confirmations embed more deeply, but people tend to focus on
verbal labels and descriptions rather than the bodily experience itself. Exercises that help
clients develop greater bodily awareness, as well as explorations about how and why they
prevent themselves from experiencing the bodily connection, can assist therapeutic
growth. As clients attend to bodily communications about their core constructs, they gain
greater clarity and understanding regarding how meanings facilitate and hinder effective
living. Techniques that enhance awareness of bodily experiences, such as relaxation
training and mindfulness training, may have psychotherapeutic power to the extent that
therapy draws a connection between bodily processes and meaning-making (Leitner &
Faidley, 2008).
Context Centered Psychotherapy (CCP)
CCP (Efran & Green, 1996; Efran, Lukens, & Lukens, 1990; Efran & Nash, 2004)
describes human life as an inherently meaningless ‘drift’ to which people add purpose
and infer meaning. Participation in this drift occurs without choice, and thoughts arise
without conscious decision. Words like choice and free will, although they affect
people’s lives, do not represent a separate reality. Thus, some words and concepts prove
inaccurate, and effective living requires understanding how thought processes function.
CCP addresses the context, the individual’s presuppositions that normally operate in the
background. By labeling and describing contexts, clients can experience how
contextualized thoughts arise and dissolve away.
CCP distinguishes between ‘mind,’ self-centered survival mechanisms, and ‘self,’
the recognition of connection with the totality of the universe (Efran & Soler-Baillo,
2008). ‘Self’ views ‘mind’ as a component, rather than the whole person. However,
protective mental strategies may dominate over experience and awareness. CCP assists
clients mental operations, acknowledging and accepting them rather than trying to change
the mind’s content. Like meditation, “the objective is not to directly banish troublesome
thoughts or extinguish unwanted behaviors. In fact, as many therapists have learned,
directly challenging the mind is generally a futile exercise” (Efran & Soler-Baillo, 2008,
p. 91). CCP engages clients in a conversation focusing on the precise use of words,
particularly those distinguishing between mind and self, and contrasts the mind’s
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emphasis on survival with the self’s focus on living. The therapist aligns with the client’s
self to ‘tame’ the client’s overactive mind, shifting emphasis from “from the smaller
context of mind to the larger context of self” (Efran & Soler-Baillo, p. 94). Life’s
inherent lack of meaning provides an opportunity for people to create their own meaning,
cultivating awareness of a larger view and a variety of available solutions.
Identity Systems and Bridging
Block (2005) focuses on the Human Identity System, which helps develop
individual identity and a sense of self. It often evolves into a self-centered, rigid, and
exclusive sense of overall identity that restricts the ability to attend to actual experience.
Building on Beck’s (1989, 1993) Everyday Zen approach, thoughts, or ‘requirements,’
similar to core constructs (McWilliams, 2000), reinforce a sense of the self as damaged or
defective. Requirements dictate how to behave and feel and how events in the world
must unfold in order to meet them. Unfilled requirements lead to distress and fear, and
futile attempts to satisfy them. Storylines about what must occur to repair the damage
reinforce belief in this all-encompassing self-concept, defining the person as incomplete,
lead to insensitivity to actual bodily experience. Block uses ‘bridging’ to shift awareness
from the Identity System to immediate physical sensations, such as sights, sounds, or
bodily sensations, ‘resting’ the Identity System or placing it on ‘idle.’ Bridging practice
‘befriends’ the Identify System, by gaining familiarity with its requirements, and
experiencing how they restrict life experience. By shifting attention to immediate bodily
experience, thoughts ‘take a backseat’ to sensations, awareness expands, and the body
relaxes. Bridging practice does not strive for relaxation, which would constitute another
requirement.
Block describes several bridging exercises, formulations of Buddhist meditation
techniques: ‘tuning in’ to background sounds, attending to bodily sensations, recognizing
‘Channel Me,’ (storylines, life dramas, fantasies, pet peeves), and labeling thoughts, to
acknowledge, and befriend the Identity System. As with other awareness practices,
bridging does not attempt to alter these experiences, but rather to gain awareness of them.
Mind-Body Mapping exposes the workings of the Identity System by generating a ‘wordpicture’ of the system’s activity. Bridging practice begins with recognizing the Identity
System as it arises (tension, worry, requirements) and attending to immediate sensations.
It progresses to preventing thoughts from becoming requirements through labeling, and
then to spontaneous, immediate acknowledgment of thoughts and ‘letting go.’
Mindfulness Based Cognitive Therapy (MBCT)
MBCT adapts mindfulness-based stress reduction (Kabat-Zinn, 2005) to a
psychotherapeutic context (Segal et al., 2002; Segal, Williams, & Teasdale, 2004;
Teasdale, 1999). It distinguishes between metacognitive knowledge as used in cognitive
behavioral therapies, which helps clients recognizes ‘inaccurate’ cognitions, and
metacognitive insight, which assists clients in directly experiencing thoughts as events in
awareness, rather than reflecting external reality. Therapy requires not just intellectual
understanding but also experiential learning, assisting clients to view thoughts and
feelings as ever-changing events, and to experience direct insight with respect to specific
thoughts and feelings as they appear. They focus on changing the client’s relationship to
thoughts and feelings, rather than the traditional cognitive therapy focus on the content of
thoughts and feelings (Teasdale, 1999). MBCT helps clients to recognize their tendency
toward “self-perpetuating patterns of ruminative negative thought” (Segal et al., 2002, p.
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75). It changes the focus from the content of the thought to the process, by identifying a
‘doing mode,’ which focuses on the discrepancy between desires and actual experience
along with ‘shoulds’ and ‘oughts,’ which focus on changing an unsatisfactory experience.
It teaches a contrasting ‘being mode’ in which the client accepts and allows thoughts and
feelings to pass through awareness. By tolerating the discomfort that normally leads
clients to ‘do something’ to fix it, clients experience freshness and freedom.
Acceptance and Commitment Therapy (ACT)
Resting on a contextual and pragmatic theory of language and cognition (Hayes,
2005; Hayes, Strosahl, & Wilson, 1999), ACT provides a well elaborated and empirically
tested psychotherapy approach with clear parallels to Buddhist views (Hayes, 2002,
2004; Forsyth & Sheppard, 2009). It emphasizes how verbal evaluations and
comparisons, useful for solving problems and planning for the future, amplify human
suffering by comparing personal experience to desired or feared events. Attempts at
avoiding experiences that arouse upsetting emotions and thoughts, etc., paradoxically
sustain and evoke the experiences and deflect attention from the immediate environment.
Attempts to explain and understand the situation, as a means of control, further
exacerbate resistance to change and lead to useless rumination and worry. ACT defines
psychological health as living in accordance with personally chosen values while also
maintaining contact with immediately experienced bodily sensations, thoughts, and
feelings. Its interventions aim to increase acceptance of experience, make personal
choices, and take appropriate action by reducing the tendency to fuse thoughts with
experience, weakening experiential avoidance, accepting troublesome sensations,
feelings, and thoughts willingly, contacting a sense of self that transcends ever-changing
thoughts and sensations, clarifying important life values, committing to behaving in
accordance with those values, and continuously attending to, acknowledging, and
accepting thoughts and feelings. Interventions include paradoxical language techniques,
confronting clients with the consequences of avoidance, deliberate exposure to
unpleasant experiences, observing self-processes, clarifying meaning and values, and
monitoring commitment to actions.
Dialectical Behavior Therapy (DBT)
Linehan (1987) found that therapy focused exclusively on change led to
increasing resistance and experiencing the therapist as invalidating. Alternatively, by
dropping an emphasis on change and accepting the client, clients experienced the
therapist as insensitive and uncaring. These polar alternatives led to a synthesis of the
two, a model of maintaining a balanced emphasis on both acceptance and change. This
synthesis led to the dialectical conception of this approach. Robins, Schmidt, and
Linehan (2004) describe their model as rooted in Hegel’s conception of phenomena as
arising and passing away, always in the process of change. It seeks an understanding of
the whole, viewed as a relationship of parts that do not possess independent significance.
The parts and the whole exist in interdependent, indivisible relation to one another, with
the whole greater than the sum of the parts, embracings the dynamic nature of events,
seeing reality as a verb rather than a noun, and a pragmatic notion of knowledge as a
human process based on stated goals. DBT assists clients to develop a more accurate
worldview and more effective behaviors. Mindfulness, on the part of the therapist and as
a skill taught to clients, synthesizes acceptance, through observing and participating in
the moment without judgment, and adopting effective new action. DBT teaches clients to
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accept life completely as it is as well as to change it, emphasizing that openness to
experience without distortion or judgment does not mean appraising the experience
positively.
Extending Constructivist Psychotherapy Integration
Constructivist psychotherapy and Buddhist-inspired psychotherapy share
fundamental assumptions regarding the interconnected, integral, and ever-changing
nature of the universe and a view of knowledge as constructed by humans as a means of
organizing their experience, making meaning, guiding actions, and achieving goals. Such
compatibility provides an opportunity to consider mindfulness, awareness, and
acceptance methods as a means of expanding constructivist psychotherapy’s theoretically
progressive integration. Metatheoretical compatibility provides a necessary condition for
considering other approaches for integration. However, selecting methods for integration
might also include assessing the approaches’ compatibility at the level of formal theory,
clinical theory, and strategies and techniques (Neimeyer, 1993, 2009). In particular, the
case for integrating mindfulness, awareness, and acceptance methods with constructivist
psychotherapy could benefit from a rationale demonstrating the relevance of these
Buddhist-inspired techniques to the goals of constructivist psychotherapy. Personal
Construct Psychology’s ‘personal scientist’ metaphor might provide a useful context for
considering this particular relevance.
Kelly (1955) suggested that we can view people as operating similarly to
scientists. People develop meaning-based theories or beliefs based on their perception of
recurrent patterns of experience, test their beliefs and interpretations by identifying goals
and establishing hypotheses for anticipating specific events, attend to the actual outcome
of predicted events, and revise understanding based on the extent to which the current
events validate the anticipation. As stated earlier, constructivism defines psychological
well-being as the extent to which a person’s interpretations lead to validated anticipations
and revision in light of their predictive effectiveness. A Buddhist view of psychological
well-being can support the constructivist perspective by emphasizing how mental
balance, and acknowledging the ever-changing essenceless nature of phenomenal
experience, can assist in more effective anticipation. The four interconnected components
of a Buddhist view of well-being (Conative-, Attentional-, Cognitive-, and AffectiveBalance; Wallace and Shapiro, 2006) described above represent mind-sets useful to the
effective personal scientist’s anticipation of events and revision of understanding.
Effective personal science includes creating meaningful hypotheses, which requires clear
articulation of relevant and meaningful goals (Hayes, 1993). Conative balance
emphasizes establishing realistic desires and goals that will lead to fulfillment for the self
and others. Likewise, generating theories and testing hypotheses requires the ability to
focus sustained attention on relevant events and the observation process itself. Mindful
awareness practice enhances attentional balance and the ability to monitor mental states
and interpretations of experience as they occur. Effective development of meaning-based
understanding, testing hypotheses, and revising understanding requires openness to
perceiving and experiencing events clearly and the ability to consider alternative
perspectives. Wallace and Shapiro (2006) describe this capability as cognitive balance,
which “entails engaging with the world of experience without imposing conceptual
assumptions or ideas on events” (p. 696). Cognitive balance includes attending to
present-moment experience of sensations, perceptions, emotions, and mental processes.
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Finally, well-being and effective meaning-making may benefit from emotional
equilibrium, avoiding extremes of hyperactivity or apathy, by cultivating affective
balance through equanimity, empathy, compassion, and caring.
Buddhist-inspired methods that foster greater mindful awareness of thoughts,
beliefs, and feelings, attention to immediate events, and acceptance of actual experience
may enhance the effectiveness of constructivist psychotherapy. Focus on the processes
underlying the use of thoughts and language, rather than only on their content, helps
liberate clients from attachment to rigid dysfunctional thoughts and actions, promoting
more effective construing and clearer perception of events. These skills support a larger
sense of meaning, freedom from automatic responses and rigid identifications, and more
flexible ways of addressing ever-changing events. The examples discussed above
demonstrate that contemporary psychotherapists have effectively applied mindfulness,
awareness, and acceptance methods to a variety of approaches with a variety of client
populations. These methods may assist in further strengthening the effectiveness,
relevance, and utility of constructivist psychotherapy, contributing to its on-going
elaboration and to its theoretically progressive integration.
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