Review of General Psychology1997, Vol. 1,No. 4,375-388

Copyright 1997 by the Educational Publishing Foundation1089-268O/97/S3.O0

The Social-Cognitive Construction of Psychotherapeutic Change:Bridging Social Constructionism and Cognitive Constructivism

Jack Martin and Jeff SugarmanSimon Fraser University

Self-with-other processing and construction play an important role in human adjust-ment, development, and change. This idea is critical for an adequate understanding ofpsychotherapy and psychotherapeutic change. A theory of psychotherapeutic changethat combines elements of both social constructionist and cognitive constructivistthought is presented briefly. After reviewing salient examples of both forms of thoughtas these have manifested in theorizing about psychotherapeutic change, a sampling oforiginal empirical demonstrations is offered in support of the theory. Psychotherapeuticchange is described as a process of appropriation and practical application throughwhich clients internalize therapeutic conversations and activities, which they then useas psychological tools to restructure personal theories, experiences, and actions.

The theory of psychotherapeutic changepresented in this article is nested within a largertheory of psychological development (see Mar-tin & Sugarman, in press) that attempts tointegrate important insights from social construc-tionist and cognitive constructivist thought insocial science and psychology. In this moregeneral bridging theory, the individual is seen toarise from the social, but is not isomorphic with,nor reducible to, the social. It is preciselybecause the individual is not an exact replica of,and to some extent can transcend the social, thatvarious kinds of human psychological transfor-mation such as learning, psychological change,and creative innovation are possible. Such aview goes beyond standard formulations ofeither social constructionist or cognitive con-structivist thought, while bearing an affinitywith some of the ideas central to classic forms ofsymbolic interactions as developed by Dewey(1929), Mead (1934), and Vygotsky (1934/

Jack Martin and Jeff Sugarman, Faculty of Education,Simon Fraser University, Burnaby, British Columbia,Canada.

An earlier draft of this article was presented as part of asymposium on constructing self, others, and relationships:the social-cognitive-clinical interface conducted at themeeting of the American Psychological Association, Toronto,Canada.

Correspondence concerning this article should be ad-dressed to Jack Martin, Faculty of Education, Simon FraserUniversity, Burnaby, British Columbia, Canada V5A 1S6.Electronic mail may be sent via the Internet tojack_martin@sfu.ca.

1986). It also continues and extends theemphasis on self-with-other development andchange that is often stressed in social cognitivepsychology. Knowing one's self intrapsychi-cally springs from, but goes beyond, knowingone's self interpersonally.

In psychology and social science, socialconstructionism (Gergen, 1985; Harre, 1984;Shorter, 1993; Shorter & Gergen, 1989) holdsthat psychological phenomena, from the ways inwhich thoughts occur to the ways in whichpeople are able to conceive of ourselves assubjects, are conversational and interrelationalat root. Psychological activity, viewed initiallyas a kind of conversational analogue, is seen toarise from and to reflect people's immersion indiscursive social relational practices. It isthrough involvement in such practices thatpeople acquire, develop, convey, and conferupon others the symbolic cognitive tools throughwhich we manage our psychological engage-ment with the world. The means for organizingthought and forging and expressing experientialand imaginal constructions, derive from ourattunement to relational practices, the mostconspicuous being conversation.

The primary theoretical strength of socialconstructionism is that it provides a plausibleaccount of the way in which individual psychol-ogy arises and initially becomes organized. Theemphasis on the pivotal role of ordinaryconversation and other relational practices in thegenesis of psychological phenomena helps todemystify the source of emergent, agentic

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individuality, requiring nothing more in the wayof biological assumptions than a set of primitiveneurophysiological potentials to move about inthe world of experience, and to perceive andremember some of what is experienced.

In contrast, cognitive constructivism, owingto the works of individuals such as Bartlett(1932), Piaget (1954), and Kelly (1955), presup-poses a more atomistic view of psychologicalchange. As a cognitive perspective, constructiv-ism ascribes primacy to the role of theindividual in learning and psychological devel-opment. Constructivists conceive of hypotheti-cal learning mechanisms or processes intrinsicto the nature of human individuals. Thesemechanisms or processes are believed to presideover the individual's development, serving toconstruct, manipulate, transform, and appendthe various mental representations and organiza-tions that comprise the individual's cognitivearchitecture. Although it is not unusual forcontemporary cognitive constructivists (e.g.,Mahoney, 1990) to acknowledge the importanceof social influences on individuals' develop-ment, they persist in maintaining a strongseparation between the individual and the social,construing individual psychological develop-ment as taking place against broader patterns ofinterpersonal, social, and cultural interaction,but not as constituted of such patterns andforms. The focus is on the individual and howshe or he learns to negotiate individual needsand purposes in sociocultural contexts.

A major theoretical conundrum for cognitiveconstructivism concerns the matter of howindividual minds comprehend or affect otherminds, a question of obvious importance whenconsidering any kind of psychological interven-tion. This difficulty lies in the failure of anindividually sovereign process of cognitiveconstruction to explain how human beings areable to share so much socially—to interpret,understand, influence, and coordinate theiractivities with one another. How is the intricatecoordination and systematization plainly osten-sible in human social interaction possible, givenan isolated, self-contained, individualistic pic-ture of the process of cognitive construction?Moreover, there is the developmental questionof how on one's own, without the resources ofthose discursive practices people use reflexivelyto partition experience, an individual couldcome to develop a sense of self. Without such

resources, it is difficult to understand how onecould take up practices such as labelingexperiences as one's own, and recollecting one'sexperiences in autobiographical fashion.

Social constructionism deals with these diffi-culties by revealing common social foundationsfor psychological development and processes ofthought. Individual psychology is grounded in,and enabled by, a shared sociality of conversa-tional and interrelational practices. These prac-tices are continuously reproduced and promotedby members of a culture. They constitute a formof life. People are thrust into this collectivityfrom birth, and are constrained in many ways todevelop within the discursive and relationalcontext it provides. In this light, humanpsychology is shown to be much less sovereign,isolated, subjective, and individually relativisticthan cognitive constructivism would imply.

However, social constructionism presents itsown obstacle, one that holds fundamentalimportance for any investigation into thetransformative aspects of human developmentand psychology, such as those central topsychological therapy. The knot is, assuming theconstraint of extant sociocultural practices onwhat human beings can think and become, whataccounts for variation or transformation inindividual understanding, knowledge, and behav-ior? How is transcendence of conventionalsocially embedded and realized wisdom pos-sible? Neither the strong possibility that theforms of human psychology arc derived fromconversation and other relational practices, northe likelihood that such practices are essential tothe collective evaluation and negotiation of newideas as these are introduced to the public realmanswers the question of where new ideas comefrom in the first place. Social constructionismprovides a convincing explanation for howpeople become informed with experience, under-standing, and knowledge, but it is wanting withrespect to explaining how we are able totransform experience, understanding, and knowl-edge.

Indeed, a strong social construedonist reading(e.g., Derrida, 1978; Gergen, 1991) would seehuman psychology as completely constrainedby the kinds of conversation and social relationfound in social experience. As merely amanifestation of conversations and social rela-tions, especially as captured in language sys-tems, individual agents dissolve into the dia-

SPECIAL ISSUE: SOCIAL-COGNITIVE CONSTRUCTION IN PSYCHOTHERAPY 377

logue and social roles in which they supposedlyare created and compelled to participate. Thereis little of human agency here, only socialrelational, linguistic structures that by them-selves seem to cause phenomena that give onlythe appearance of being psychological. In thislight, the transformative and agentic capacity ofindividuals appears of little relevance.

It is, however, extremely doubtful thatindividual agency can be made to disappear soeasily. The problem is that this sort of poststruc-tural social constructionism begs the question ofwhat it is that social influences are acting toconstrain. What is happening here is a fundamen-tal confusion about the relation between socialstructures and human agency. Human agents arenot merely the invention and expression ofsocial structures. Further, social and linguisticstructures are very much the invention andexpression of human agents. These structuresconstrain the expression of human agency, butonly by virtue of the fact that human agentsapply their understanding of social conventionsto assess the merits of their intentions andbehavior. The power of social and linguisticstructures and conventions derives not fromtheir manipulation of passive human organisms,but from their use by human agents who activelyadopt and interpret them in light of their ownlives and circumstances.

It is true that the methodological individual-ism of cognitive constructivism occludes thesociocultural origins of human psychology.Consequently, cognitive constructivism miscon-strues the largely social origins of psychologicaldevelopment. However, cognitive constructiv-ism does recognize the importance of an activeagent intimately involved in the figuring of itsown psychology. Although humans exist in asociocultural world of persons, a distinguishingcharacteristic of personhood is the possession ofan individual agentic consciousness. In ourlarger work (Martin & Sugarman, in press), wetheorize in detail about how truly reflexiveforms of human intentionality, enabled byincreasingly sophisticated capabilities of memoryand imagination, gradually emerge from peoples'initial participations as prereflective agentswithin the preexisting sociocultural contexts intowhich people are thrown at birth and through whichpeople gradually develop as genuinely psycho-logical individuals. We argue that in thisdevelopmental process the very ontological

status of individual psychology shifts in waysthat render problematic the ontologically cat-egorical, radically dualistic, and static accountsof most philosophers since Descartes.

It certainly is the case that individualism andselfhood have drawn a great deal of critiquethroughout the humanities and social sciences(e.g., Sampson, 1983). However, an importantdistinction needs to be drawn. Much critique ofthis kind attacks, probably rightly, an invidioussort of individualism that slights or ignores thecollective aspects of human existence, severingus from an essential part of ourselves andundermining any genuine sense of community.Nonetheless, the danger here is that suchcritiques might encourage ignoring the veryreal, unique sensibilities and understandings wedevelop as individuals in sociocultural engage-ment with others. It is difficult to imagine anyform of psychological theorizing that ignoresthe ineluctable phenomenal sense of agency andindividualism in human experience. What isrequired is a consideration of this kind ofindividual experience within the broader contextof human development, including the conditionsof possibility and constraint that mediate theessential interplay between the individual andsociety. It is precisely such consideration that weattempt in our book, The Psychology of HumanPossibility and Constraint: Bridging SocialConstructionism and Cognitive Constructivism(Martin & Sugarman, in press). It would be bothimpossible and inappropriate to attempt tosummarize here the various philosophical,psychological, and empirical arguments wedevelop in this volume. However, we attempt toprovide a summary of the way in which ourlarger theoretical perspective plays out in theunderstanding of psychotherapeutic change. Abrief recapitulation of social constructionist andcognitive constructivist perspectives on psycho-therapy sets the stage for this summary.

Social Constructionism and CognitiveConstructivism in Psychotherapy

For the most part, theories of psychotherapeu-tic practice have emphasized conceptual founda-tions more similar to those held by cognitiveconstructivists than to those promoted by socialconstructionists. Given that psychotherapy at-tempts to induce change in clients' ways ofexperiencing, living, problem solving, and

378 MARTIN AND SUGARMAN

coping, it makes sense that psychotherapeutictheories of practice tend to focus on thecapacities of individuals for change, coping, andresolution of their problems and difficulties.This emphasis on individualistic forms ofchange and development also is consistent withthe standard form of psychotherapy as practicedin Western cultures, consisting primarily ofconversational interaction between an indi-vidual psychotherapist and an individual client.For example, one of the first forms of psycho-therapy to be widely practiced was that devel-oped by Sigmund Freud (1914/1966). Althoughhe was certainly concerned with happenings inclients' life experiences outside of the therapeu-tic hour, Freud devoted most of his theory andpractice to the uncovering of supposedly re-pressed memories, the reenactment and reexpe-riencing of events symbolized in those memo-ries, and the apparently resultant resolution ofclients' dysfunctional symptoms and lifestyles.

Only during the 1920s to the 1960s waspsychotherapy cast as a process of socialconstruction, and then only by a minority oftheorists and practitioners of psychotherapywho identified with very narrow, reductionisticversions of behavioral psychology. For the mostpart, these approaches to psychology and topsychotherapy bore little resemblance to contem-porary social constructionist thinking. Wherethe behaviorists were concerned primarily withhabitual forms of experiencing, thinking, andacting, supposedly tied directly to specificenvironmental triggers, true social construction-ism suggests that knowledge does not resideexclusively either in the minds of individuals orin the environment, but rather in the socialprocesses of symbolic interaction and exchange.

More recently, there arc indications that morebonafide forms of social constructionist thoughtarc beginning to find their way into the thinkingand theorizing of some scholars and practitio-ners of psychotherapy. This is most notable inthe work of Gergen (Gergen & Gergen, 1991;McNamee & Gergen, 1992) and others whohave advocated a postmodern variant of socialconstructionism that

draws attention to the manner in which conventions oflanguage and other social processes (negotiation,persuasion, power, etc.) influence the accounts ren-dered of the "objective" world. The emphasis is thusnot on (he individual mind but on the meanings ofpeople as they collectively generate descriptions andexplanations in language. (Gcrgen & Gergen, 1991,p. 78)

Such postmodern forms of social construction-ism (also see Lather, 1992; Sampson, 1983)move away from traditional emphases ofpsychotherapy theorists on the individual self,sometimes going so far as to talk about the deathof the self, implying a dissolution of anyconception of individuality as a unitary entitydistinguishable from activity within the sociocul-tural milieu. Such deconstructionist scholarshipcelebrates the demise of the sovereign indi-vidual and its replacement by more anonymousforms of ongoing social exchange. As Sass(1992) observes,

Instead of the old pathos of distance—... the conditionof an inner self cut off from some unattainablereality—we enter into a universe devoid of both objectsand selves: where there is only a swarming of"selfobjects," images and simulacra filling us withoutresistance, (p. 176)

However, as already noted, truly socialconstructionist, self-less psychologies are mostlyabsent in the area of psychotherapy theory andpractice. Perhaps more so than any other area ofapplied psychology, psychotherapeutic theoriesof practice have tended to embrace cognitiveconstructivist views. Clearly, such perspectivesare naturally friendly to the institution ofWestern psychotherapy. Following Neimeyer(1995), most extensions of constructivisticthought in the area of psychotherapy may besubsumed under five basic metaphors: (a)therapy as personal science, (b) therapy as thedevelopment of self, (c) therapy as conceptualrevision, (d) therapy as a kind of narrativeconstruction, and (e) therapy as conversationalelaboration. For the most part, mainstreamcognitive and cognitive-behavioral psycholo-gies, including contemporary work in the area ofsocial cognition and cognitive development,have contributed heavily to notions of therapy asself development and as reconstruction ofpersonal schema or conceptual frameworks.

The metaphor of therapy as personal scienceinvolves viewing the client in psychotherapy asa scientist actively formulating and testingpersonal hypotheses, and adjusting systems ofpersonal hypotheses and theories in light ofexperiential tests and feedback. This, of course,is the fundamental proposal of George Kelly's(1955) personal construct psychology. Psycho-therapy theorists like Epting (1984), Neimeyerand Neimeyer (1987), and many others havedeveloped extensive models of psychotherapybased on this central idea. However, the

SPECIAL ISSUE: SOCIAL-COGNITIVE CONSTRUCTION IN PSYCHOTHERAPY 379

metaphor of therapy as personal science alsohas been attractive to many cognitively orientedpsychotherapists who have interpreted the no-tion of personal science in traditional logical,empiricist ways, maintaining only a semblanceof Kelly's brand of constructivism (e.g., Meich-enbaum, 1977, who incorporates some ofVygotsky's work into a generally cognitivecon structi vistic view of psychotherapy andpsychotherapeutic change).

Therapy as the development of self harkensback to very early forms of psychoanalytictheorizing about the acquisition of early maladap-tive schemas that were thought to underlieserious psychological disturbance. Currently,many scholars of psychotherapy have begun tofocus again on early developmental stages(Freeman, 1993) or attachment relationships(Bricker, Young, & Flanagan, 1993) in whichvarious disordered self-schemas are thought toarise, a terrain once exclusively the property ofpsychodynamic therapists.

At least two influential theorists, Guidano(1987, 1991) and Liotti (1986), have combinedthe therapeutic metaphor of self developmentwith that of personal science. Liotti (1986)explicitly models his conceptualization of thestructure of self and other personal theories afterthe structure of scientific research programsdeveloped by Lakatos (1970). He identifiesthree levels in an individual's cognitive organi-zation that correspond to Lakatos' programmaticlevels of metaphysical hard core, protective belt,and actual research plans. The core level of anindividual's cognitive, theoretical organizationis composed of schemata that are formed duringchildhood and adolescence, and which are heldtacitly by the individual as unquestionableassumptions about important aspects of self andreality. The intermediate level—or protectivebelt—of an individual's cognitive, theoreticalorganization consists of "protective" verbaliz-able descriptions of one's self, other people, andthe world. Here, Liotti (1986, p. 98) stresses thepolarized, dichotomous character of these con-structions and explicitly relates them to Kelly's(1955) conceptualization of personal constructs.The explicit descriptions of the intermediatelevel function to protect the core assumptions anindividual holds about self and reality. Finally,the peripheral level of individual cognitive,theoretical organization encompasses the plansof action and the problem solving strategies theindividual uses to navigate the demands of daily

life. Appraisals, evaluations, interpretations, andreactions to daily events, while arising from amultilevel interaction between these events andall three levels of an individual's cognitive,theoretical organization, are manifested at thisperipheral level.

In a similar vein, Guidano (1987, 1991)elaborates the complexity of self as coevolvingwith a capacity for inter subjectivity in humanrelationships. The self envisioned by Guidano(1991) is a dynamic process of "constructionand reconstruction of a reality capable ofmaking consistent the ongoing experience of theordering individual" (p. 5). Central to Guidano'sdynamic organization is a dialectical interplaybetween the experiencing " I" and an explainingself, an interplay that results in a continuousreordering of self and reality. This kind ofdevelopmental analysis plays out in therapeuticmethods in which clients attempt imaginalreplications of affectively charged scenes fromtheir past, scenes implicated in the constructionof clients' current sense of self.

The metaphor of therapy as self developmentalso has been elaborated by Martin (1994) andBuirs and Martin (1997), who have incorporatedMarkus's theory of possible selves (1983;Markus & Nurius, 1986; Markus & Wurf, 1987;Oyserman & Markus, 1990) into their formula-tions. Markus and her colleagues believe that anindividual's complete self-theory (self-concept)actually is made up of various representations ofself that are potentially available to the con-scious awareness of the individual. The contentsof a person's self-theory at any given moment(i.e., the working self-concept) are some subsetof the contents of the complete self-theory. Inaddition to those self-representations readily athand in the working self-theory, there are manyother self-representations that are potentiallyavailable as sources for redescribing one's goalsand purposes. The self-representations poten-tially available to an individual's working selftheory vary in their structure and function. Someare well developed and fully elaborated, andmight be considered to be central or core to anindividual's complete self-theory. Others aremore peripheral and less well elaborated. Someare positively valenced, whereas others carrynegative affective, attitudinal associations. Inthis sense, it is possible to speak about bothpositive and negative selves, or more precisely,positive and negative possibilities for the self.Possible selves are theories of potential selves

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that are formed on the basis of imaginings builton past experiences (direct and vicarious),supplemented by conditions experienced at thetime of imagining.

The third constructivist metaphor in psycho-therapy, that of therapy as conceptual revisionto mental schema or frameworks, has beenadvanced consistently by cognitively orientedpsychotherapy theorists and practitioners. Forexample, Albert Ellis (1962) attempted tointegrate the Stoic philosophy of Epicetus into apractical guide for recognizing and eliminatingbasic irrational ideas that he thought wereresponsible for a wide range of human misery.Since then, Ellis and numerous other rationalconstructivists have developed this basic ideainto a complex system of rational emotive andbehavioral psychotherapy that attempts to recon-struct the basic beliefs of individuals along morerational adaptive and functional lines (e.g.,Dryden, 1984). Of course, a whole generation ofapplied psychologists since the early 1970s haspracticed various forms of cognitive behaviormodification in which the supposedly dysfunc-tional thoughts and behaviors of clients seekingpsychotherapy are targeted for focused forms oftherapeutic reconstruction and revision. Influen-tial contributors to cognitive-behavioral psycho-therapy have included Meichenbaum (1977),Mahoney (1980, 1990), and Beck (1967, 1976).

Perhaps the largest body of contemporaryempirical literature in psychotherapy from acognitive-behavioral perspective has been stimu-lated by Aaron Beck's (1967, 1976) approach tounderstanding and treating depression. Beckbelieves that depressive schemas are negativeviews (informal theories) of the self, the world,and the future. These negative schemas operatein the experience of depressed individuals tobias negatively their cognitive/perceptual pro-cessing and behavioral selection in ways thatcontinuously confirm the content of theseschemas. Empirical research in this tradition(e.g., Derry & Kuiper, 1981) has focused onanalyzing the functions of depressive self-schemas, defined as hierarchically organizedbodies of knowledge stored in clients' memo-ries. A good deal of research (cf. Kuiper &Higgins, 1985) now exists that usually isinterpreted as demonstrating how the negativelyslanted, personal schemas (theories) of de-pressed clients bias their understandings andinterpretations of their life experiences as

essentially sad, meaningless, and hopeless, andlead to behavioral patterns of withdrawal,excessive criticism, and general miserableness.A wide variety of cognitive-behavioral psycho-therapeutic interventions have been developedand researched as possible means of alteringsuch dysfunctional schemas (cf. Mahoney,1995).

A fourth constructivistic metaphor for psycho-therapy and psychotherapeutic change is that oftherapy as narrative reconstruction. Narrativeor storied approaches to understanding humanchange processes in general, have becomeextremely popular with psychotherapy research-ers and scholars in the 1980s and 1990s.Narrative psychologists like Bruner (1986),Mair (1988), McAdams (1988), Polkinghorne(1988), Sarbin (1986), Howard (1991), Vogel(1994), and White and Epston (1990) haveinfluenced recent depictions of psychotherapyas "life-story elaboration, adjustment, or repair"(Howard, 1991, p. 194). These recent develop-ments have highlighted the contemporary rel-evance of earlier, slightly more socially construc-tionist construals of psychotherapy as aninterpersonal, social process aimed at elaborat-ing and revising the styles, scripts, and storiesthrough which clients lead their lives (Adlcr,1963; Berne, 1961; Rosen, 1982).

The final constructivist metaphor of therapyas conversational elaboration fits nicely withvarious construals of psychotherapy as narrativereconstruction and as schema revision. Inpsychotherapy, the therapeutic conversation hasthe potential of assisting clients to elaboratemeanings resident in their personal schemas,theories, or stories. Proponents of the conversa-tional elaboration metaphor regard humans asquiniessentially language generating, definingtheir organization through discourse and negotia-tion. Meaning is seen as arising throughcommunicative action, as opposed to residingwithin individual selves. In this regard, psycho-therapy becomes an exercise in co-creativecreation of language within a problem-solving,problem-organizing system. Systemic therapiespracticed by a new generation of familytherapists (Feixas, 1990; Penn, 1985; Procter,1987) illustrate the conversational elaborationmetaphor. Such approaches to psychotherapyhighlight the role of the psychotherapist inelucidating and subtly challenging the contrac-tual agreements, meanings, and organizations

SPECIAL ISSUE: SOCIAL-COGNITIVE CONSTRUCTION IN PSYCHOTHERAPY 381

that solidify relationships within a family,sometimes in highly dysfunctional ways. Thetherapist functions as a conversational managerattempting to co-construct a new story with thefamily, one that has a sense of coherence and isperceived as relevant to the concerns of itsmembers.

Clearly, cognitive constructivist work hasbeen influential in psychotherapy theory, re-search, and practice. In several of the metaphorswe have examined, especially the final metaphorof therapy as conversational elaboration, thereexist possibilities for social constmctionistincursions into such work, but these remain forthe most part underdeveloped. Nonetheless, theradical individualism and radical constructivismreplete in most psychotherapy literature fre-quently has led critics (e.g., Szasz, 1961; Taylor,1989) to challenge the entire edifice of Westernpsychotherapy, its practitioners, and its organiza-tions and institutions for placing undue empha-sis on what such critics see as rather limitedpossibilities for significant human change resi-dent in individuals who more realistically areportrayed as overwhelmed by socioculturalpractices inimical to their positive psychologicalfunctioning.

Few attempts exist to integrate social constmc-tionist and cognitive constructivist thought in anunderstanding of psychotherapy practice. Oneexception is the work of William Lyddon(1995). Lyddon attempted to analyze the diver-gent philosophical bases of the various construc-tivist metaphors and theories existing in the areaof psychotherapy. In particular, he made assump-tions associated with Pepper's (1942) taxonomyof world hypotheses to differentiate the differentforms of psychological constructivism he findsin psychotherapeutic theorizing. He concludedthat although differences among these variousforms of constructivist psychology may besomewhat unsettling, they all might reflectviable accounts of different aspects of humanknowing. A full understanding of the construc-tive nature of human knowing may require inputfrom all such metaphors.

Consistent with Lyddon's general approach,but also incorporating more decidedly socialconstructionist views, Martin (1994) previouslyattempted to conceptualize psychotherapeuticchange in a manner generally consistent with thekind of bridging of social constructionism andcognitive constructivism with which we are

concerned. We adopt much of this earlieraccount in the following description of psycho-therapeutic change.

Summary of a Theory ofPsychotherapeutic Change

The primary general implication that flowsfrom our theoretical bridging of social construc-tionism and cognitive constructivism (Martin &Sugarman, in press) is that human development,learning, and change exhibit a kind of con-strained or limited possibility. Ourunderdetermi-nation thesis (to the effect that individualpsychology, particularly following the develop-mental acquisition of genuinely reflexive capa-bilities of memory and imagination, is necessar-ily underdetermined by participation and experiencein sociocultural contexts) allows for the innova-tive emergence of new ways of thinking andacting, but the general sociocultural origins ofthese phenomena constrain these emergentpossibilities. Peoples' ability to learn from ourencounters with previously unexperienced prac-tices and forms of knowing always is imper-fectly determined by our experiential pasts andwhat we have taken from them.

Gadamer's (1960/1975) metaphor of fusedhorizons is apt here. Human learning and changemay be viewed as the emergence of newhorizons of understanding or being. Thesehorizons are somewhat different from both thepractices and forms resident in novel sociocul-tural experiences and those practices and formsresident in an individual's previous modes ofunderstanding and being that have been drawnfrom past experience. The constantly emergentindividual is thus caught up in an ongoingdynamic process of fusion, immersed in theunfolding panorama of practical and epistemicsources potentially available in lived experi-ence, in interaction with those already takenfrom such experience. With this general view inplace, and in light of the foregoing summary ofsocial constructionist and cognitive constructiv-ist thought in the area of psychotherapy, we offerthe following description of psychotherapy andpsychotherapeutic change. Not only does thisaccount incorporate more of a social construc-tionist perspective than is common in extanttheorizing in this area, but it integrates andstreamlines several of the kinds of constructivis-lic metaphors and accounts surveyed above.

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In our account, psychotherapy itself is con-ceived as a somewhat unique, socially sanc-tioned interpersonal activity devoted to assistingindividual members of a society to change (cf.Martin, 1994). It is assumed that humanexperience occurs in the context of cultural,social, interpersonal, and personal conversationsand other relational practices. Human thoughtand forms of understanding are appropriatedfrom these conversations and practices andinternalized in individuals' memories and emer-gent understandings. Indeed, memories of pastexperience in conversations and relational prac-tices act as primary mediational vehicles for theinternalization of forms of thought and under-standing. Personal theories emerge as patterns ofbelief based on internalized forms of thoughtand understanding. Such theories about self,others, the world, and one's situation supportand enable experiential, affective, motivational,and cognitive processes (including values,reasons, dispositions, and goals) on whichhuman actions are based. When individuals'current theories and the actions they support donot permit the attainment of personal goals,acceptable resolutions to personal problems orconcerns, or acceptable levels of personalcoping, individuals suffer emotional upset andseek change.

Psychotherapy is a unique form of socialconversation and interpersonal activity thatattempts to help individuals to alter theirpersonal theories so as to permit more effectivegoal attainment, problem resolution, or personalcoping. Psychotherapists work collaborativelywith clients to elaborate clients' current theoriesthrough facilitating memory-mediated recall,interpretation, and analysis of past and currentexperiences and understandings in the context ofthe therapeutic conversation. A wide variety ofdiscourse methods is available for use in thisshared effort to portray clients' experientialworlds—for example, storytelling, analogy,metaphor, imagery, and argument. Dependingon the exact form of psychotherapy used,relational activities accompanying the therapeu-tic use of such conversational methods mightinclude role plays, experiential exercises, emo-tionally heightened reminiscences of recent ortemporally distant life experiences, rationalanalyses, systematic observation, journal writ-ing and sharing, and other social and interper-sonal variations and combinations. Some of

these conversational methods and relationalactivities are highlighted in the descriptions ofrelevant empirical demonstrations that follow.

Psychotherapists also work collaborativelywith clients to help clients revise their theories,once these have been elaborated. Such revisionis achieved by clients' internalization of thetherapeutic conversations and activities throughwhich their personal theories have been elabo-rated, interpreted, and analyzed. Ultimately,clients who have benefited from psycho therapeu-tic conversations and practices are potentiallycapable of contributing to the personal, interper-sonal, social, and cultural contexts in which theyexist in ways that alter these conversations,practices, and their experiences in them.

In the same way in which individual psychol-ogy itself develops from participation andexperience in sociocultural settings, but isnecessarily underdetermined by those expo-sures, possibilities for psychotherapeutic changeare constructed in the social context of psycho-therapy, but are not entirely constrained by thesepsychotherapeutic interventions. As reflexiveagents, in possession of developed capabilitiesof memory and imagination, clients inevitablyadapt what they take from psychotherapy totheir unique extracurricular life circumstancesand their understanding and interpretation ofthose circumstances and of themselves. Theextent of the resultant psychotherapeuticallyfostered change in clients lives and circum-stances undoubtedly depends on numeroustherapeutic and extratherapeutic factors. Avariety of therapeutic methods potentially mightfacilitate such change, including the use ofhomework assignments, planned extratherapeu-tic exercises and experiments, and preparatoryfantasy dialogues and role plays.

Having provided this straight-forward sum-mary of psychotherapeutic change in termsconsistent with our attempt to bridge socialconstructionist and cognitive construedvisticaccounts of psychological development in gen-eral, we want to stress that the constructivedynamics of psychotherapeutic change do notdiffer in kind from those more general construc-tive dynamics that enable all human psychologi-cal development and change. We also want tostress that the quality and quantity of therapeuticchange in any given case inevitably will dependon the nature (variety, depth, breadth, and soforth) of the lived experience afforded to an

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individual client prior to, during, and afterexperience in the psychotherapeutic context.

Relevant Empirical Demonstrations

We turn now to a program of empiricaldemonstrations that we interpret to support thepossibility and plausibility of the foregoingtheoretical account of psychotherapeutic change.A good illustration of how clients in psycho-therapy internalize therapeutic conversations,and how such internalizations can come tofunction as useful psychological tools forclients, occurs in a case study conducted early inthis research program (Martin, 1987). The clientin this case study was a 35-year-old woman whowas suffering verbal and physical abuse from aman with whom she lived. Immediately follow-ing each of eight sessions of psychotherapy, thewoman was asked to free-associate to her ownname, the name of her partner, brief phrasesdescribing her problems, and possible solutionsto her problems. All of the client's associativeresponses were recorded on gummed labels, oneresponse to a label. These labels then werereturned to the client so that she could organizethem on a sheet of laminated paper, indicatingrelationships among the words or phrasescontained on the labels by placing related labelsin greater physical proximity or by usingglass-marking pencils to draw connecting linesbetween labels.

The client's responses to the free-associationand conceptual-mapping tasks, when comparedto audiotape recordings of the actual sessions ofpsychotherapy clearly revealed her internaliza-tton of various segments and ideas from thetherapeutic conversations. The therapeutic inter-vention focused primarily on clarifying andelaborating the client's affective reactions,providing information about relationship vio-lence, and exploring options that might alter theclient's currently dysfunctional life circum-stances. As psychotherapy proceeded, the con-ceptual maps produced by the client movedfrom displays indicative of little understandingor insight into her problems, or of possiblestrategies that might be engaged to address herproblems, to clear indications of both enhancedunderstanding and possible strategies for re-sponding to her difficulties. Affective labels inthese maps moved from references to hopeless-ness, fear, and entrapment to expressions of

anger, but also of hope. In this case, theconceptual-mapping responses of the clientwere interpreted as evidence of her internaliza-tion of psychotherapeutic conversations into herpersonal theories of her problems and possiblesolutions to them. The eventual ability of thisclient to extricate herself from the abusiverelationship she had endured, may have beenfacilitated by this process of internalization.

The completion of several such case studiesin the early phases of this research programreinforced a general neo-Vygotskian perspectivethat viewed the personal theoretical construc-tions of clients as embedded in sociocultural,historical contexts, and psychotherapy as aninterpersonal, social context that might furnishmaterial that clients might internalize, and thatmight lead to revisions in their personal theories.With such initial, exploratory work in place,Martin and Stelmaczonek (1988) conducted twomethodologically pluralistic studies that usedmethods of exploratory research and discourseanalysis in combination with those of moretraditional hypothesis-testing psychological re-search. The first study was exploratory andaddressed three questions: (a) What kinds ofevents during psychotherapy do clients andpsychotherapists identify as important? (b) Doesthe nature of such events change over time intherapy? (c) Do therapists and clients identifythe same events as important? Therapists andclients were interviewed by a research assistantimmediately following the completion of eachof eight psychotherapy sessions and asked toidentify "the most important things that hap-pened during the session." Both therapists andclients most frequently recalled as important sixcategories of therapeutic events. Four types ofevents related to the therapeutic task of enhanc-ing clients' personal awareness. The remainingtwo types of events related to the therapeutictask of revising personal theories. These resultswere interpreted to demonstrate a therapeuticprocess that involved the promotion of clients'awareness of their personal theories, and theirsubsequent revision of those theories throughpsychotherapeutic intervention.

The second study reported by Martin andStelmaczonek (1988) used a similar methodol-ogy, but tested an a priori hypothesis to theeffect that discourse during psychotherapeuticevents recalled as important by clients woulddiffer from discourse in temporally proximate

384 MARTIN AND SUGARMAN

control events in ways consistent with resultsfrom experimental cognitive psychological re-search on determinants of memorability. To testthis hypothesis, discourse during recalled-important and control events was transcribedand coded for such characteristics as depth ofmeaning, elaboration of meaning through use offigurative language, clarity, and conclusionorientation. Results of inferential statisticalcomparisons revealed that client-recalled impor-tant therapeutic events were reliably character-ized by significantly more of these discoursecharacteristics. The events that clients recalledas important were ones in which therapists andclients attended to the meanings of clients'experiences, elaborated these meanings throughthe use of figurative language, and attempted todraw conclusions concerning clients' experi-ences.

A second part of the second study by Martinand Stelmaczonek (1988) provided informationconcerning clients' ability to recall, at a 6-monthfollow-up, events they had identified as impor-tant immediately following the psychotherapysessions studied. Clients were cued to recall byhaving them view a 1 -min videotaped segmentfrom the start of each of the therapy sessions inwhich they had participated. Results were thatclients recalled accurately the same events theypreviously had identified as important in 73% ofthe cases tested. The accuracy with which suchtherapeutic memories were maintained overtime constituted a surprising, unexpected demon-stration of memorial persistence, especiallywhen considered in relation to the inaccuracyand decay evident in participants' memories oftasks undertaken in the laboratories of experi-mental cognitive psychologists. Such a demon-stration hinted at the possibility that memoriesfor material that is endowed with personalmeaning and significance may be much moreenduring and potentially influential than memo-ries for more detached material relatively devoidof such significance and meaning.

The results of the Martin and Stelmaczonek(1988) studies were interpreted to lend supportfor the emerging theory that psychotherapyworked by somehow embedding in the minds ofclients relatively lasting episodic memories oftherapeutic interactions that could be used asbases for the reconstruction of clients1 personaltheories, and eventually for altered "real-life"experiencing and acting. A subsequent study by

Martin, Paivio, and Labadie (1990) verifiedresults obtained from the hypothesis-testingportion of the second Martin and Stelmaczonek(1988) study. Once again, client-recalled eventsfrom psychotherapy sessions differed fromcontrol events from those same therapy sessionsin terms of such discourse characteristics asdepth of meaning, elaboration of meaningthrough the use of figurative language, andconclusion orientation. Of potentially signifi-cant clinical and theoretical relevance in theMartin et at. (1990) study, it was therapists'contributions to the discourse during client-recalled important therapeutic events that contrib-uted most to the differences between theseevents and the control events. The implication ofthis result was that therapists could influenceclients' recall of therapeutic content and dis-course through the nature and manner of theircontributions to psychotherapy, conversations,and activities. Such a rinding encouraged us inour growing conviction that psychotherapeuticconversations are appropriated by clients as abasis for personal theoretical and behavioralchange, that clients' experiential or episodicmemories mediate this process of internaliza-tion, and that psychotherapists intentionally caninfluence clients' recollection of therapeuticevents by therapists' own conversation andactivity. This finding also brought to mindpreviously unreported findings from this andearlier studies (see Martin, 1994) concerning arelatively common error in client recollectionsof therapeutic events. Even while quite accuratewith respect to the content of therapeuticdiscussions and interactions, it was not unusualfor clients in these studies to attribute tothemselves contributions to therapeutic dis-course that actually were made by therapists.The possibility that therapists might intention-ally be able to influence client recollections oftherapeutic interventions began to loom large.

A subsequent study by Martin, Cummings,and Hallberg (1992) attempted a direct test oftherapists' influence on clients' recollection oftherapeutic events through the intentional use offigurative language. Therapists in this studyattempted to use therapeutic metaphors when-ever they judged that such metaphoric interven-tion might promote legitimate client therapeuticwork and was appropriate to the currenttherapeutic context. Immediately after therapysessions were completed, therapists and clients

SPECIAL ISSUE: SOCIAL-COGNITIVE CONSTRUCTION IN PSYCHOTHERAPY 385

were asked to recall therapeutic events theyfound to be most memorable and to give reasonsfor the memorability of these events. Partici-pants also rated each session in terms of itshelpfulness and effectiveness.

Specific hypotheses were (a) that clientswould tend to recall events associated withtherapists' intentional use of therapeutic meta-phors, and (b) that clients would rate sessions inwhich they recalled therapists' intentional meta-phoric interventions higher than sessions inwhich they did not recall therapists' intentionalmetaphoric interventions. The rationale for thesecond hypothesis was the assumption thatclients tend to recall therapeutic events whenthey have succeeded in deriving meaning fromthem. Thus, sessions during which therapists'intentional metaphoric interventions were re-called might contain more of such personallymeaningful associations than sessions duringwhich therapists' intentional metaphoric interven-tions were not recalled. Such meaningfulconsideration and recollection seems to contrib-ute to client perceptions of session effectivenessand helpfulness.

Clients recalled therapists' intentional use ofmetaphor in approximately two thirds of thesessions in which metaphors were used intention-ally by therapists. Metaphors that were recalledtended to be developed collaboratively throughthe active participation of both therapists andclients. With respect to clinical impact, clientsrated sessions during which they recalledtherapists' intentional metaphors as significantlymore helpful than sessions during which theydid not recall therapists' intentional metaphors.

The study by Martin et al. (1992) wasinterpreted as verifying the ability of therapiststo contribute intentionally to therapeutic dis-course in ways that influenced clients' internal-ization and recollection of specific therapeuticcontent. As such, results of this study were seento confirm a central proposition with respect toan emerging theory of how psychotherapyworks: that psycho therapeutic discourse can beintentionally constructed in the social, publicdomain of psychotherapy with generally predict-able effects on the personal, private construc-tions (memories and theories) of clients.

More recently, a study by Burrs and Martin(1997) provides evidence of the dual legacy ofexperiential constraints and possibilities onclients' ability to use psychotherapeutic interac-

tions as a basis for personal change. Thequestion guiding this research concerned theextent to which the conversational constructionof possible selves during psychotherapy isconstrained by past and present extratherapeuticsocial, interpersonal experiences of clients. Sixclients (all substance abusers) expressed, ex-plored, and attempted to synthesize their feel-ings and experiences during two role plays inwhich they imagined two future scenarios. Inone scenario, the negative possible self role-play, the clients imagined that their problemswith substance abuse remained unchanged. Inthe other, the positive possible self role-play,they imagined that these problems had beenovercome. All six clients were more likely toexpress directly feelings and experiences in thenegative possible self role-play than in thepositive possible self role-play.

Such a result is consistent with a strong socialconstructionist view that would locate theorigins of current psychological experience inone's history of experience in relevant socialcontexts. The fact that all six clients were activesubstance abusers probably made it easier forthem to enact the negative possible selfrole-plays with greater expressions of feelingand experience than they displayed during theless familiar, positive possible self role-plays.Nonetheless, there were dramatic and webelieve reliable indications that clients' participa-tion in the less familiar, positive possible selfrole-plays enabled them to synthesize newlyrealized or more fully recognized feelings andexperiences more so than in the negativepossible self role-plays. We believe that thissecond result provides some confirmation of thepossibility that psychotherapeutic constructionsmight be internalized by clients as sources ofpotential revision to their existing theoreticaland experiential beliefs and practices, supple-menting and augmenting emergent capabilitiesof active functional memory and imagination.Our faith in this interpretation is strengthenedfurther by the many examples of clients'recollection and apparent internalization ofpsychotherapeutic discourse and experience inthe earlier studies summarized above.

Concluding Comment

Taken together, the various studies in theprogram of psychotherapy research reported

386 MARTIN AND SUGARMAN

illustrate many aspects of the view of psychologi-cal development and psychotherapeutic changethat we have presented here (see also Martin &Sugarman, in press). The program of researchbegan with a general neo-Vygotskian templatethat was seen to be supported in initial casestudy research. Subsequent studies in theresearch program attempted to explore theoperation of this neo-Vygotskian template inmore specific ways, ways embedded in theconduct of actual psychotherapy, and attemptedto provide empirical demonstrations of particu-lar propositions within this theoretical template.In particular, as the research program devel-oped, demonstrations were attempted in whichpsychotherapists intentionally tried to influenceclients' internalization and recollection of psy-chotherapeutic discourse and experience. Suchdemonstrations support several key propositionsin the theoretical view of psychotherapy as aunique form of social conversation and interper-sonal activity that attempts to help clients toalter their personal theories through a process ofinternalizing therapeutic discourse that elabo-rates and revises relevant personal theories ofclients. At the same time, the study by Buirs andMartin (1997) brings to mind that such possibili-ties for change always are constrained byrelevant sociocultural experiences, past andpresent, of clients.

More generally, we believe that psycho-therapy might best be understood as a humancreation grounded in the historical and contem-porary renderings given it by virtue of cultural,social, and personal notions of psychologicalhealth and healing. Psychotherapy is part of asociocultural tradition of conversation andpractice, one by which people attempt to alterour personal theories about ourselves and ourlives. These are theories that people haveextracted from our life-long participation in ourfamilies, our friendships and relationships, oursocieties, and our cultures, but which currentlydo not serve us well in assisting us to reach ourgoals, resolve our problems, or cope withcurrent life situations. In this sense, psycho-therapy is simply a professionalized version ofthe ongoing quest to extract more meaningfulunderstandings of ourselves and our world fromour interactions in the physical and socioculturalworlds we occupy and to which we contribute.

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Received April 7, 1997Revision received June 24, 1997

Accepted June 24, 1997