6 - Can psychotherapeutic interventions overcome epistemic difference?

Summary

Psychotherapy, indeed the very notion of mental illness and its treatment, are predicated on a modernist epistemic paradigm (Kvale, 1992; Doucet et al, 2010). Modernism became the dominant epistemic paradigm in the Western world in the 17th century, when empiricism and reason replaced the idea of direct revelation from God as a way to approach the truth. Modernism in psychotherapy implies a vision of a practitioner who is value-free, objective and unbiased. Postmodernism appeared in the 20th century and questions the very notion of objective truth. Its influence in psychotherapy involves the therapist's awareness of operating from within specific language and sociohistorical frameworks (Lyddon & Weill, 1997).

Kelly (1955) noted that patients try to understand what is going on in their lives in much the same way as scientists try to develop hypotheses about the world; patients have constructions of their reality as scientists have theories. If we understand the psychotherapeutic process as one of scientific interchange and as a form of knowledge generation, we may understand that therapists and patients adopt different roles with differing expectations, depending on the epistemic paradigm they embrace (independently of the awareness they have of it).

The German word Weltanschauung (world view) has been extensively used in psychology to refer to sets of assumptions that people use to understand and describe their lived experience of reality. Koltko-Rivera (2004) defines world view as ‘a set of beliefs that includes limiting statements and assumptions regarding what exists and what does not (either in actuality, or in principle), what objects or experiences are good or bad, and what objectives, behaviors, and relationships are desirable or undesirable’.

We define epistemic mismatch in psychotherapy or counselling as a phenomenon that would occur when the epistemic vision of therapist and patient belong to different paradigms. This phenomenon may happen in the meeting between people of different cultures whose epistemic views are incompatible (Owusu-Bempah, 2004). A common scenario would be an encounter between a modernist therapist and a patient whose world views collide with rationalism, who relies on mysticism to explain the world. A similar mismatch might occur when a therapist from a more individualistic culture (governed by autonomy or self-determination) tries to understand a patient from a communitarian culture, in which a healthy person is seen as one who is deeply embedded in the community, and self is defined by mutual roles and relationships.