Developing a ‘just therapy’: context and the ascription of meaning

Charles Waldegrave

in Discursive Perspectives in Therapeutic Practice

Published on behalf of Oxford University Press

Published in print April 2012 | ISBN: 9780199592753
Published online February 2013 | e-ISBN: 9780191754715 | DOI:

Series: International Perspectives in Philosophy & Psychiatry

Developing a ‘just therapy’: context and the ascription of meaning

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The ways in which meanings are ascribed often indicate both the nature of the relationship and the understandings that can be expected to ensue. If, for example, a school teacher says to a young pupil that they need to complete a task or there will be consequences, then it is reasonably clear that the teacher is drawing upon his or her senior status to direct the pupil. When a member of the police force says the same thing to another adult it carries an authoritative nuance that is quite different from the nuance of a woman speaking to her partner, or an employee addressing his or her boss. Human beings are very sensitive to meaning. They perceive the nature and value of relationships through the meanings they understand emanate from the other.

‘Just therapy’ grew out of a seed that sought to distinguish the branches of meaning in therapeutic encounters. It grew in a soil of disenfranchised people, who though vulnerable and searching for help, were often subject to established and prescribed trunks of assessment and direction. These therapeutic prescriptions carried with them the claims of professionalism to neutrality and higher knowledge, and in so doing, often bypassed the fundamental core of meaning that had developed among the people they were designed for. Although cultural boundaries and expectations differed, the fields were ploughed as though every paddock was the same. Gender differences and socioeconomic status distinctions played a minor role when compared with the universality of the chosen therapeutic direction.

The ‘just therapy’ approach, by contrast, privileges the notion of context as being critical to a person's or family's health and well-being rather than universal approaches (Waldegrave et al. 2003a). ‘Context’ refers to the impact and ongoing influence of the lived experience of people from their earliest, given relationships to their mature choices and expressions of culture, gender, and to a lesser extent socioeconomic positioning. Although genetic inheritance is a major determinant of individual functioning, people learn to value certain ways of acting in the world over others through the primary expressions of care they receive that in turn impart culture, socioeconomic status, and gendered cues. These cues take on specific meanings, and words with associated emotions and body cues amplify those meanings.

People learn to interact and communicate through explanations and modelling from the intimate group they are born into or placed in. Their sense of security, predictability, and order stems from this contextual mixture of cultured and gendered experience of belonging, and is also influenced by the socioeconomic position through which it is expressed (Erikson 1950; Gerhardt 2004; Quintana et al. 2006). They learn the behaviours that are considered to be acceptable and those that are shameful. Socioeconomic status in modern democracies is more fluid than it used to be, and changes for some people during the course of their lifetime.

Chapter.  7974 words. 

Subjects: Psychiatry

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