The Postmodern & Social Justice Lineage
The tradition that asked: who decides what is normal, and whose interests does that serve?
Clinical and evidence statements in this lineage remain under review. The source checks below apply only to their stated treatment, population and outcome.
Guideline sources for approaches in this lineage
SFBT
Guidelines and official sources (2)
1 clinical guideline check · 1 professional reference check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- TIP 39: Substance Use Disorder Treatment and Family Therapy, Chapter 3
Discussed in the source
SAMHSA TIP 39 discusses solution-focused brief therapy and supporting research. This is a treatment-improvement reference rather than an unspecified registry endorsement.
Scope: Families affected by substance-use problems.
- Clinical Practice Guideline for Management of Stroke Rehabilitation
Discussed in the source
The guideline discusses SFBT among pooled psychological interventions and makes a neutral recommendation for the broader prevention category. It does not separately grade SFBT as a treatment for established depression.
Scope: SFBT included in the review of interventions to prevent depression following stroke.
Motivational Interviewing
Guidelines and official sources (14)
13 clinical guideline checks · 1 professional reference check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Alcohol-use disorders: diagnosis, assessment and management (CG115)
Recommendation for the stated population
NICE recommends an initial motivational intervention incorporating key MI elements. CG115 is alcohol-specific, not a blanket all-substances endorsement.
Scope: People who misuse alcohol, at initial assessment
- Enhancing motivation for change in substance use disorder treatment (TIP 35)
Discussed in the source
TIP35 gives clinical implementation guidance for motivational interviewing. Label it as a SAMHSA treatment manual, not a graded CPG recommendation.
Scope: Substance-use-disorder treatment
- Clinical Practice Guideline for Diagnosis and Treatment of Hypertension in Primary Care
Discussed in the source
VA/DoD names motivational interviewing as a way to deliver lifestyle support. This implementation sidebar does not assign MI a separate evidence grade.
Scope: Lifestyle support alongside home blood-pressure monitoring for hypertension.
- Management of First-Episode Psychosis and Schizophrenia
Insufficient evidence for or against
VA/DoD finds insufficient evidence for or against motivational interviewing for medication adherence in schizophrenia. This conclusion concerns the stated outcome and population.
Scope: Adults with schizophrenia; improving medication adherence.
- Clinical Practice Guideline for the Management of Substance Use Disorders
Discussed in the source
The guideline distinguishes MI from MET, which adds systematic assessment and personalized feedback. Its named MET recommendations should not be read as separate recommendations for every use of MI.
Scope: MI principles within structured motivational enhancement therapy for substance-use disorders.
- Clinical Practice Guideline for Tobacco Use Treatment
Recommendation for the stated population
VA/DoD weakly recommends MI to increase treatment engagement. This recommendation concerns entering treatment, rather than the abstinence effect of MI used alone.
Scope: Adults who use tobacco or nicotine; engagement in cessation treatment.
- Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea
Discussed in the source
The discussion advises a patient-centered motivational interviewing approach to encourage engagement in insomnia treatment. It does not grade MI as a standalone insomnia treatment.
Scope: Encouraging adults reluctant to engage in CBT-I or brief behavioral treatment for insomnia.
- Management of Adult Overweight and Obesity
Discussed in the source
The guideline describes MI techniques for engagement, while noting limited evidence for follow-through with weight-management treatment. This practice guidance is not a separately graded MI recommendation.
Scope: Engagement with recommended weight-management treatment in adults with overweight or obesity.
- Use of Opioids in the Management of Chronic Pain
Discussed in the source
MI appears among non-opioid care options and in tapering studies. The guideline weakly supports collaborative tapering but is neutral on specific tapering strategies; it does not separately grade MI.
Scope: Chronic pain care and collaborative opioid tapering.
- Clinical Practice Guideline for Management of Stroke Rehabilitation
Insufficient evidence for or against
VA/DoD finds insufficient evidence for or against solution-focused psychological interventions, explicitly including MI. This neutral finding concerns prevention, not treatment of established depression.
Scope: Preventing the onset of depression following stroke.
- Clinical Practice Guideline for Psychological and Other Nonpharmacological Treatment of Chronic Musculoskeletal Pain in Adults
Discussed in the source
APA reports insufficient evidence for this comparison. The table groups these approaches without assigning separate protocol grades.
Scope: Knee osteoarthritis; the reviewed CBT/motivational-interviewing/pain-coping-skills category versus usual care.
- Clinical Practice Guideline for Multicomponent Behavioral Treatment of Obesity and Overweight in Children and Adolescents: Current State of the Evidence and Research Needs
Insufficient evidence for or against
APA finds insufficient evidence to prefer MI or other selected components over alternatives. This does not recommend MI alone or address eating-disorder treatment.
Scope: Ages 2–18 with overweight or obesity; MI as one component of a family behavioral program.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Discussed in the source
WHO discusses motivational interviewing findings, but the recommendation names CBT and contingency management. Inclusion in the review is not a separate recommendation for MI.
Scope: Adults with cocaine or stimulant dependence.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Discussed in the source
Motivational interviewing is discussed within the reviewed psychosocial interventions. WHO conditionally recommends structured psychosocial treatment as a group, with low-certainty evidence, while noting uncertainty about individual therapy types versus usual care.
Scope: Adults with alcohol dependence.
Motivational Enhancement Therapy
Guidelines and official sources (4)
4 clinical guideline checks
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Alcohol-use disorders: diagnosis, assessment and management (CG115)
Discussed in the source
NICE recommends a motivational intervention containing key elements of motivational interviewing. This passage does not separately recommend the full MET protocol.
Scope: Initial assessment of people who misuse alcohol.
- Clinical Practice Guideline for the Management of Substance Use Disorders
Recommendation for the stated population
VA/DoD suggests MET among treatment options for both disorders, considering preference and availability. These are weak recommendations for the structured MET intervention, rather than a single brief conversation.
Scope: Adults with alcohol- or cannabis-use disorder.
- Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder in Adults
Insufficient evidence for or against
APA finds insufficient evidence to prefer sequential over concurrent delivery, or vice versa. This is not a recommendation about MET alone.
Scope: Adults with PTSD and co-occurring SUD; MET followed by PE versus MET delivered with PE.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Discussed in the source
Motivational enhancement is included in the reviewed motivational-interviewing category. The positive recommendation names CBT and contingency management, rather than MET.
Scope: Adults with cocaine or stimulant dependence.
Narrative Exposure Therapy
Guidelines and official sources (5)
3 clinical guideline checks · 2 professional reference checks
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Evidence summary: psychological treatments for PTSD in adults
Recommendation for the stated population
ISTSS gives NET a Standard recommendation, distinct from its Strong category.
Scope: Adults with PTSD
- Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder in Adults
Recommendation for the stated population
APA conditionally recommends NET as a second-line adult PTSD treatment.
Scope: NET for adults with PTSD compared with no intervention or treatment as usual
- Clinical Practice Guideline for Management of PTSD and Acute Stress Disorder
Insufficient evidence for or against
VA/DoD finds insufficient evidence for or against NET for PTSD. This assessment does not determine its status for other conditions.
Scope: Individual psychotherapy for adults with PTSD.
- mhGAP evidence profile STR1/STR2: PTSD psychological interventions
Discussed in the source
NET is included in the trauma-focused CBT evidence grouping. This does not establish a separate WHO conflict-settings recommendation.
Scope: Adults with PTSD
- mhGAP evidence profile STR1/STR2: PTSD psychological interventions
Discussed in the source
The evidence profile includes kidNET in individual trauma-focused CBT. The strong STR2 recommendation concerns the treatment category, rather than a separate rating for kidNET or adult NET.
Scope: Children and adolescents with PTSD; the review includes kidNET.
Person-Centered Therapy
Guidelines and official sources (1)
1 clinical guideline check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Depression in adults: treatment and management (NG222)
Discussed in the source
NICE names protocol-based counselling for depression. It does not name every Rogerian/person-centred approach, and its current categories are less and more severe depression.
Scope: Adults with less or more severe depression; validated depression counselling protocols
Every other lineage in psychotherapy, whatever its internal debates, shares a modernist assumption: there is a reality to be discovered, a pathology to be treated, an expert who knows. The postmodern lineage challenged all three. Drawing on Foucault's analysis of power, Derrida's deconstruction, Wittgenstein's language philosophy, and social constructionism, these therapists asked: Who defines "mental illness"? Whose knowledge counts? What is therapy doing when it diagnoses, interprets, and prescribes? The clinical result was a family of approaches — narrative therapy, solution-focused brief therapy, collaborative therapy, Open Dialogue — that rejected the expert position, privileged local knowledge, and treated language as constitutive of reality rather than a window onto it. The social justice extension — feminist therapy, relational-cultural therapy, liberation psychology — made explicit what was always implicit: therapy is political, and the personal is inseparable from the structural.
Full Contents
Read all 14 entries as a single page
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Ludwig Wittgenstein (Later)
The later Wittgenstein: meaning is use. Language does not represent a pre-existing reality — it constitutes reality through "language games" embedded in "forms of life." There is no private language; meaning is inherently social.
Concepts: Language games · Forms of life · Family resemblance · Meaning as use · Philosophical therapy (dissolving problems through clarifying language)
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Michel Foucault
Power/knowledge: every claim to knowledge is also a claim to power. The "psy-disciplines" (psychiatry, psychology, psychotherapy) don't merely describe mental illness — they produce it as a category. Diagnosis is not neutral observation but an exercise of institutional power. The clinic is a site of surveillance, not just healing.
Concepts: Power/knowledge · Discourse · Normalization · Panopticism · Subjugated knowledges · Genealogy · Technologies of the self
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Jacques Derrida
Deconstruction: every text (and every identity, diagnosis, or clinical theory) contains internal contradictions, exclusions, and hierarchies that can be revealed and destabilized. There is no meaning outside of context, and context is unbounded.
Concepts: Deconstruction · Différance · Binary oppositions · Presence/absence · Trace · Supplement
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Tom Andersen & Reflecting Teams
Invented the reflecting team: a group of therapists observes the session, then openly shares their reflections while the family listens — then the family responds. Radical transparency replaced the one-way mirror. The therapist's thinking becomes visible and accountable.
Concepts: Reflecting team · Transparency · Multiple perspectives · Appropriately unusual · Inner and outer dialogue
Relation: Andersen's reflecting team dissolved the hidden power of the expert team behind the mirror. It embodied the postmodern commitment to transparency, multiplicity, and the distribution of authority. Adopted by Open Dialogue as a core practice.
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Steve de Shazer & Insoo Kim Berg
Created Solution-Focused Brief Therapy — the most radically future-oriented approach. The problem's history, cause, and even its nature are irrelevant. What matters: what do you want instead? When has it already happened? What works? The miracle question, scaling questions, and exception-finding are signature tools.
Concepts: Miracle question · Scaling questions · Exception finding · Pre-session change · Compliments · Solution talk vs. problem talk · If it works, do more of it
Relation: From the MRI brief therapy tradition (the attempted solution is the problem) but went further: not only is the cause irrelevant, so is the problem itself. De Shazer was influenced by Wittgenstein's language philosophy — therapy is a language game, and "solution talk" creates different realities than "problem talk."
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Harlene Anderson & Harold Goolishian
Collaborative therapy — the therapist takes a "not-knowing" stance. The client is the expert on their own life. Problems exist in language and are dissolved through new conversation. No assessment, no diagnosis, no strategic planning, no interpretation.
Concepts: Not-knowing stance · Collaborative dialogue · Client as expert · Language systems · Mutual inquiry · Dissolving problems through conversation
Relation: The most radical postmodern clinical position. Anderson and Goolishian argued that the therapist has no privileged access to truth about the client. Therapy is genuine conversation — not technique disguised as conversation. Influenced by Gadamer's hermeneutics and social constructionism.
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Michael White & David Epston
Created narrative therapy — the most influential postmodern clinical approach. People live by stories; some stories are problem-saturated and dominant, others are preferred but marginalized. Therapy externalizes the problem, searches for unique outcomes, and helps the person re-author their life.
Concepts: Externalization · Unique outcomes / sparkling moments · Re-authoring · Dominant story / alternative story · Absent but implicit · Definitional ceremony · Outsider witness · Therapeutic documents · Double listening
Relation: White drew on Foucault (power), Derrida (deconstruction), and Bruner (narrative). Epston brought the ritual and document practices. Narrative therapy is the most philosophically grounded clinical approach in psychotherapy — every technique traces to an epistemological commitment.
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Liberation Psychology
Psychology must be decolonized. Martín-Baró (assassinated in El Salvador, 1989): psychology should serve the oppressed, not the powerful. Fanon: colonialism produces psychological damage that cannot be healed without political liberation. Freire: critical consciousness (conscientização) is both educational and therapeutic.
Concepts: Conscientização (critical consciousness) · Decolonization · Internalized oppression · Concientización · Psychosocial trauma · Preferential option for the poor
Relation: Liberation psychology is the most radical extension of the postmodern-social justice lineage. It argues that individual therapy without structural change is incomplete — and potentially complicit. This challenges the entire edifice of Western psychotherapy, including its postmodern variants.
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Social Constructionism
Reality is socially constructed through language, interaction, and shared meaning-making. "Mental illness," "the self," "the family" — these are not natural kinds but cultural constructions that could be otherwise. Gergen brought this into psychology; it became the epistemological foundation of postmodern therapy.
Concepts: Social construction of reality · Language as constitutive · Multiple selves · Relational being · Local knowledge vs. expert knowledge
Relation: Social constructionism is the bridge between philosophy and clinic. If reality is constructed in language, then therapy — as a linguistic practice — can reconstruct it. This justified the entire postmodern clinical project.
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The Feminist Critique
The personal is political. Feminist therapy argued that women's psychological distress is inseparable from gendered power structures — patriarchy, violence, economic inequality. Diagnosis pathologizes responses to oppression. Therapy must address power, not just symptoms.
Concepts: The personal is political · Gender-role analysis · Power analysis · Empowerment · Egalitarian therapeutic relationship · Social action as therapy
Relation: Feminist therapy anticipated the postmodern turn by decades — questioning expert authority, analyzing power, and insisting that context (social, political, economic) is not background but central. Miller's "Toward a New Psychology of Women" (1976) laid groundwork for relational-cultural therapy.
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Relational-Cultural Therapy
Human development happens through growth-fostering relationships — not through separation and individuation (the dominant developmental model). Disconnection, not dependence, is the source of suffering. Mutuality, empathy, and authenticity are the mechanisms of change.
Concepts: Growth-fostering relationships · Central relational paradox · Controlling images · Relational resilience · Mutual empathy · The myth of separation
Relation: RCT directly challenged the Western developmental model (Erikson, Mahler) that privileges autonomy over connection. By centering relationship as the unit of development, it bridges feminist therapy with attachment theory and challenges the individualism embedded in most therapeutic models.
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Open Dialogue
Finnish approach to psychosis. All treatment decisions are made in open meetings with the patient, family, and clinical team. Immediate response (within 24 hours), social network involvement, psychological continuity, tolerance of uncertainty, dialogue as method — not medication as first response.
Concepts: Open meetings · Tolerance of uncertainty · Dialogism (Bakhtin) · Social network · Polyphony · Immediate response · Psychological continuity
Relation: Open Dialogue is the most institutionally radical postmodern approach — implemented in a public health system for psychosis, achieving outcomes that challenge the biomedical model. Integrates Bakhtin's dialogism, reflecting teams, and systemic family therapy. Demonstrates that postmodern principles can work with the most severe presentations.
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Multicultural & Decolonial Therapy
Multicultural competence is not an add-on — it is the fourth force in psychotherapy (after psychoanalytic, behavioral, humanistic). All therapy is cultural therapy. Western diagnostic categories, treatment models, and concepts of self reflect specific cultural assumptions that do not translate universally.
Concepts: Cultural competence / cultural humility · Fourth force · Microaggressions · Racial identity development · Indigenous healing practices · Decolonial psychology · ADDRESSING framework
Relation: The multicultural movement forced every other lineage to examine its cultural assumptions. CBT, psychoanalysis, humanistic therapy — all developed in specific Western cultural contexts. Multicultural therapy asks: for whom were these models built, and who do they exclude?
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Motivational Interviewing
A collaborative conversation style for strengthening a person's own motivation and commitment to change. Not directive, not confrontational — evocative. The spirit of MI (partnership, acceptance, compassion, evocation) is more important than the techniques.
Concepts: Spirit of MI (partnership, acceptance, compassion, evocation) · Change talk · Sustain talk · OARS (open questions, affirmations, reflections, summaries) · Developing discrepancy · Rolling with resistance
Relation: MI is often classified as humanistic (Rogerian roots) but its epistemology is postmodern: it trusts the client's own knowledge and motivation over the therapist's expert assessment. It rejects the confrontational approach to addiction and replaces it with collaborative exploration — a postmodern move in a field dominated by paternalism.