Say you’re applying for accreditation to a counselling or psychotherapy body (like the British Association for Counselling and Psychotherapy) or writing an essay on your model of therapy, and want to say that you’re ‘pluralistic’. What are the things that could help you put together a compelling and coherent case?
Be clear about the methods and ideas that your pluralistic work is based on. Pluralism is like the bread in a sandwich. It’s the framework within which you practice is based. But what’s the filling? Do you, for instance, offer person-centred methods of listening and reflection, or Gestalt two-chair work? And, obviously, what you offer needs to be what you’re trained in—so be clear where that knowledge and expertise comes from.
A ‘pluralistic perspective’ or a ‘pluralistic practice’? In the pluralistic field, we’ve distinguished between pluralism as a way of thinking about therapy as a whole (that lots of different approaches can be of value), and pluralism as a specific practice (where different therapeutic methods and ideas are drawn together to accommodate the preferences of the individual client). Both can be written about in any description of your therapy, but be clear about which one, and what you mean, when.
Understand the philosophical underpinning. Pluralism, either as a perspective or as a practice, isn’t just about chucking together lots of things and hoping for the best. It’s rooted in a deep, ethically-founded philosophy of how to relate to others and the world. Some of this philosophy is tough going but it’s essential to really understanding, in depth, what pluralism is about. Try, for instance, Connolly’s Pluralism or, for a really tough read, try some of Levinas’s work, like Totality and Infinity. There’s also some great stuff on the web, and a good place to start is with Wikipedia’s description of value pluralism, or the Stanford Encyclopedia of Philosophy’s entry on Isaiah Berlin.
Difference and diversity. Don’t leave it to last. At the heart of a pluralistic approach is a welcoming and celebration of diversity, so how do you address that in your own work: for instance, being aware of your own cultural background or positions of privilege? Some other questions: How do you actively strive to help clients from marginalised groups feel welcomed in your work, and how do you address power as a therapist? Pluralism welcomes everyone’s voice, but it also understands that some voices get more silenced than others. So how can we work to make sure that everyone feels really, genuinely heard in our work.
Why ‘pluralism’ rather than ‘integration’ or ‘eclecticism’? One of the first questions any assessor is likely to ask is why you’re describing your approach as ‘pluralistic’ rather than ‘integrative’ or ‘eclectic’, so you need to be clear about the differences (and the similarities). If you’re talking about pluralism as a practice, then you can describe it as a form of psychotherapy integration that orientates itself around clients’ particular needs and wants. Different integrative approaches do that, but it’s not inherent to integration, per se. ‘Integration’ can also refer to specific combinations of approaches, like cognitive analytic therapy, or mindfulness-based existential therapy, whereas pluralism as a practice isn’t aligned with any one model (combined or not). If you can get your head around the different forms of psychotherapy integration—like ‘theoretical integration’, ‘assimilative integration’, ‘common factors,’ and ‘eclecticism’—and where your pluralism sits with each one, that would really help (see the excellent Handbook of Psychotherapy Integration—pricey, but hopefully in your library). And remember that your approach doesn’t need to be one or the other: for instance, you might, ‘hold a common factors view of change, but practice pluralistically drawing on methods and ideas from specific theoretically integrative psychotherapies. If you’re writing about pluralism as a perspective, the differences are clearer as there’s isn’t really any integrative or eclectic equivalent. It wouldn’t really make sense to say, for instance, that you ‘practice as a person-centred therapist within an integrative worldview’, but saying that you do so within a pluralistic one makes total sense. And what, after all of this thinking, you decide that you’re maybe ‘assimiliative integrative’ or ‘common factors’ rather than ‘pluralistic’? Great, at the end of the day, what’s important is what you do with your clients, and being coherent in that, rather than what label you give to it all, per se.
Describe how, why, and when you make decisions about what you do in therapy. So right into the heart of pluralistic practice: How do you come to adopt certain ideas and methods? Yes, of course, it’s in collaboration with the client, but when do you talk about what you are going to do (for instance, at assessment sessions, the start of each session, review points); and what kinds of things do you talk about (for instance, goals, methods, formulations)? Are there, perhaps, some specific methods that you use to help identify what might be useful for the client, like timelines (see McLeod and McLeod in the Handbook of Pluralistic Counselling and Psychotherapy) or the Inventory of Preferences? And how, for instance, do you handle situations when a client wants something that you don’t think is best for them? Personally, I’d suggest emphasising dialogue, dialogue, dialogue (and, again read some in-depth texts on dialogue, like the paper here, so that your position is rich and philosophically-informed). Then, critically, you need to say something about why you are using the methods you do and the theories underpinning them (see, for instance BACP’s criterion 8.1, ‘Describe a rationale for your client work with reference to the theory or theories that inform your practice’). So, for instance, if a lot of what you can offer clients is a space to talk through their problems, why might that be helpful? What’s the theoretical and psychological basis for doing so? Here, for instance, you might draw on person-centred theory to say that, with space to talk, clients can connect more with their ‘organismic valuing potential’ and work out for themselves what is best for them to do. Or, if you work with clients to challenge their patterns of thinking, you might talk about cognitive theories of maladaptive thoughts. But, really importantly, make sure it’s logically consistent. If you say, for instance, that you trust in a client’s organismic valuing, you can’t then just describe their thinking as maladaptive. How can they be both? My latest book on an underlying integrative theory of directionality might be helpful here; or you could talk about the way that, from a pluralistic standpoint, different theories are ‘working narratives’ that suit some clients some of the time, rather than immutable truths.
Cite the evidence. There’s lots of empirical research related to pluralistic practices, and these can help to inform a critical exploration of your work. For instance, if you’re writing about accommodating clients’ preferences, you could cite the Swift et al. meta-analysis to show that preference accommodation is associated with reduced drop out and slightly improved outcomes. Or, if you’re writing about goals, have a look at the paper by Di Malta et al., which gives a rich, in-depth exploration of how clients experience goal-oriented practices: both the positives and the negatives. And, for evidence that a pluralistic approach to practice has decent enough outcomes, you can cite the paper here.
What about the problems? Pluralism is all about holding a reflective, self-critical stance towards the way that we work, so it’s essential to talk about some of the limitations of this way of working and thinking too. How much, for instance, can we really trust clients’ own assessments of what they want and need? So make sure you read some critiques of pluralism, for instance the recent paper by Ong et al from the person-centred field, or on our pluralisticpractice blog from Erin Stevens and Jay Beichman. Of course, you may well find things here that you disagree with; but what’s important is to be able to see pluralism from, well, a plurality of perspectives, and to be able to appreciate its limitations as well as the strengths.
Talk to us. And finally, do talk to us about how you’re getting on, and join in the debates. We have a website with regular blogs, and a Facebook page where some of these issues get discussed. Then, if you can make it, come along to our annual conferences which is the ideal place to talk to welcoming and like-minded people striving to develop new, open-minded ways of thinking about counselling and psychotherapy.
Just as a disclaimer, what’s here is obviously only suggestions and, if things do go ‘pear-shaped’, I’m sorry that I can’t take responsibility for that. On any application of assignment, the key thing is always to attend to the criteria set and, for instance, the BACP have some very valuable guidelines for their own accreditation process. Tutors, also, will have a much better idea of what you need to be saying; and any advice from them should over-ride what’s here.
Finally, we’d love to hear how you’re getting on: stories both of passing as pluralistic therapists, and any bumps along the way. Perhaps we can work together to iron them out. So do also share any advice you have from your own experiences of defining yourself as a ‘pluralistic therapist’. Good luck with it.