Many practicing psychotherapists find the literature on empirically supported therapies to be an informative but limited resource for understanding and addressing the range and complexity of problems encountered in actual practice. These practitioners tend to favor a range of individual, meaning-based, and narrative approaches that foster enhanced understanding in psychotherapy (e.g., gestalt, humanistic-existential, psychodynamic/object-relations). For want of a better term I refer to this group of approaches as meaning-based therapies. Meaning-based therapists share the view that the diversity of problems encountered in the consulting room—and therapeutic effectiveness—cannot be adequately understood in the context of the epistemic assumptions of the natural sciences. They emphasize the importance of the therapeutic effects of process variables and the importance of interpersonal engagement in an individualized (and relatively unstructured) process intended to generate improved understanding of experiences, actions, feelings, memories and relationships and their associated meanings. During this process various strategies are implemented to facilitate the likelihood that individual experiences and meanings will be examined, rekindled, explored, deconstructed, reconstructed, and re-connoted in ways that are broadly intended to facilitate new, more fulfilling ways of living and relating (
Kaye, 1995). Meaning-based therapy is understood as a process between a therapist and a patient, involving a unique series of semistructured interactions and related experiences that take place over time. Both therapist and patient come with unique characteristics, and the interaction that takes place in a particular context is expected to result in a reciprocal process with unpredictable emergent results (
Wampold, Hollon, and Hill, 2011). Not everyone seeking psychotherapy services is interested in, capable of, or motivated to engage in narrative therapy, similarly not everyone seeking therapy presents is primarily interested in therapies that focus on symptom reduction, and many individuals seeking psychotherapy services do not present with prominent symptom-based complaints. Many are interested in changing the trajectory of their lives in a broad sense. There are obvious limits to the degree to which meaning-based therapies can be described in manuals, as these therapies are based on reciprocal processes and responses to interventions and must accommodate the unique qualities of the therapeutic relationship as well as the background, potential, and circumstance of each individual. Meaning-based approaches may include (but typically extend beyond) symptom control (which involves help in connecting diverse sources of information and experiences, such as memories, emotions, omissions, recurring patterns and ways of relating) with the goal of living a more satisfying and effective life, having richer and more satisfying relationships, and finding new, more effective ways of having patients become more effective agents in their involvements (
Martin and Thompson, 2003). Meaning-based therapies are structured and intended to facilitate engagement in a process of exploration and mutual understanding, in ways that help reduce problems and reveal the truth in what has been previously been misunderstood, distorted, and concealed so that opportunities for new experiences are increased. Strategies are timed and applied selectively on a case-by-case basis to allow the client’s experiences to unfold through a relatively unstructured process involving openness, spontaneity, and uninterrupted communication (
Frie, 2010). The goals are to engage and influence the self-understanding of clients in a manner that is both historically and culturally grounded and idiographic, reflexive, evaluative, and related to issues related to understanding and living within appropriate limits of control and freedom, with emphasis on agency and the interpersonal and embodied basis of experience (
Frie, 2003;
Woolfolk, 1998). Meaning-based therapies are founded on the assumption that there are few facts about human problems that that can be understood apart from the meaning-laden narratives that form and shape our lives. Actions change as a result of shifts in understandings that define who we are (
Guignon, 1998). Human actions are assumed not only to be past shaped, but also to be understood in relationship to the accomplishment of specific aims and goals within the individual’s culture and life story.
Despite extensive research, evidence for the effectiveness of meaning-based therapies, they have been dismissed and described as unscientific and rejecting science because they cannot be evaluated in the context of RCT designs (
Begley, 2009). It is not that meaning-based therapists “reject science” so much as that they do not accept the epistemic limits of what is considered to be appropriate evidence characteristic in the natural-science approach to psychology. The problem for these therapists: how are claims to knowledge to be substantiated in ways that minimize the risks of relativism, self-deception, and doctrinaire authoritarianism?