Randomized controlled trials and relational cultural theory

RCT

Relational Cultural Theory

As with all disciplines research and theory develops to fill a need, something that is dissonant or out of sorts with either an individual or society. In the case of Relational Cultural Theory (RCT) it seeks to fulfill a deficiency in both. Born from the impact of disconnection of an individual to others and his or her culture at large, RCT explores the adaptive, or in many cases, the maladaptive strategies that an individual would use to fit into whatever relationship may be available. These strategies or often enacted regardless of the debilitating consequences, both emotionally and sometimes physically, that the individual may have to endure to survive. Jean Baker Miller, over many years, developed the concept of RCT in reaction to the enfeebling role that many women found themselves in.

In her book, Toward a New Psychology of Women (1976), she began to explore the fundamental differences a woman's psyche possess as opposed to the often generic & pigeonholed personality that psychologist had thus far offered:

The ideas in Miller's book emerged from her clinical practice with women in which she noted that the centrality of relationships in her clients' lives was inconsistent with the traditional theories of counseling and human development she had been taught in medical school. According to Miller and other feminist theorists of the time, these traditional theoretical models emphasize individuation, separation, and autonomy as markers of emotional maturity and psychological health. (Comstock et al. 280)

This perception was in direct opposition to Miller's clinical experience. She found that women were debilitated by the process of somewhat male dominated ideas of individuation, separation, and autonomy and not enhanced by it at all. In fact, women not only had to contend with this prejudice of personality on an individual relationship basis but with society at large, which at the time often downplayed such areas as domestic violence, further disconnecting the women involved from helping resources that may have been available.

Miller was appointed as the first director of the Stone Center at Wellesley College in 1981 and the theory building group that she had been working with since 1976 had found an home at the Stone Center. The center's mission was to study psychological development and the prevention of psychological problems. Over the next twenty years the proceedings from these colloquia of this theory group have been recorded and published as "works in progress" ad now make up the core writings that have created the fundamental concepts of RCT. (web site)

RCT has its roots in the understanding of women's psychological experience, but has now come to be a source for gaining a further comprehension of all human experience. RCT is especially involved in finding the imbalances between power and privilege in relationships and within society. (Pack-Brown, Thomas, and Seymour) Such negative events include cultural oppression, social exclusion, and other forms of social injustices, "… underlie the pain and trauma that individuals in marginalized and devalued groups routinely experience in their lives." (Comstock et al. 282)

RCT is the foundation for a growing body of research on depression, trauma, eating disorders, substance abuse, chronic illness, mother-daughter relationships, lesbian relationships, as well as issues of racism, sexism, heterosexism, classism, along with a multitude of other psychological and social problems (Hartling & Ly, 2000).

There are certainly common threads that can be found between multicultural, feminist, and social justice groups that RCT can help to fully explore. In fact RCT has assisted this particular combination of groups and a more societal and therapeutic level:

…not only do counselors who operate from multicultural, feminist, and social justice counseling paradigms direct time and energy toward stimulating positive changes among the individual clients with whom they work, they also strive to intentionally ameliorate social injustices that adversely affect the mental health of larger numbers of persons in oppressed and marginalized groups in contemporary society. (Crethar, Rivera, and Nash)

The focus that Miller and her theory group began in 1976 has certainly found fruition in the current practice of counselor and therapists on a larger scale.

One practice that RCT uses is the function of empathy in a therapeutic relationship. By creating a mutually empathic encounter, many other opportunities reveal them selves for each counselor to become more culturally effective and open minded to different relational choices of that culture. These empathic setting give both the client and counselor a chance to explore each other's worldviews and beliefs on many levels. By crating a give and take, a sharing of experience and concepts and reactions to similar situation each can come away with a deeper understanding of each other personalities and life experiences. (Comstock et al.; Jordan, "The role of mutual")

RCT further complements the multicultural/social justice movement by serving as an alternative theoretical framework from which mental health professionals can explore how issues related to sex role socialization, power, dominance, marginalization, and subordination affect the mental health and relational development of all people. (Comstock et al. 283)

In exploring that disconnection between an individual and others or society at large there are several avenues that empathic RCT explores. In responding to a disconnection the injured party is able to represent his or her feeling and the counselor is able to respond empathicaly and positively. This experience can lead to a much stronger relationship building psyches as thier feeling begin to be valued. When a person feels able to effect change and feeling effective in creating connections and managing their lives (Jordan, "Toward connection"). On the other hand, when the injured party cannot express their feeling and feel understood in a relationship, or worse when there is only the response of indifference or added injury or denial of those feelings, he or she will begin to keep those aspects out of the relationship in order to keep the relationship. In RCT, this is termed the "central relational paradox" (Miller & Stiver). In these situations, the individual begins to implement a wide variety of strategies to twist their psyches to fit into the available relationships. These are know as strategies of disconnection and makes the individual become less and less authentic (Miller, "Connections, Disconnections").

RCT provides a theoretical basis from which mental health professionals can reconsider the importance of the aforementioned relational concepts for the practice of counseling. Over time, such concepts have consistently been muted by many other counseling theorists who overemphasized therapeutic and developmental goals that are culturally and gender biased. (Comstock et al. 286)

Some of the Core RCT beliefs and theoretical assumptions that explain the complex process of both psychological and relational growth and development, can be represented as follows:

1. People grow through and toward relationship throughout the life span.

2. Movement toward mutuality rather than separation characterizes mature functioning.

3. The ability to participate in increasingly complex and diversified relational networks characterizes psychological growth.

4. Mutual empathy and mutual empowerment are at the core of growth-fostering relationships.

5. Authenticity is necessary for real engagement in growth-fostering relationships.

6. When people contribute to the development of growth-fostering relationships, they grow as a result of their participation in such relationships.

7. The goal of development is the realization of increased relational competence over the life span. (Jordan, "The role of mutual": 1007-08)

Miller also cited very specific outcomes from experiences of being in connection in stead of disconnection. She referred to these as the "five good things" as follows:

1. Each person feels a greater sense of zest (vitality, energy)

2. Each person feels more able to act and does act in the world

3. Each person has a more accurate picture of her/himself and the other person(s)

4. Each person feels a greater sense of worth

5. Each person feels more connected to other persons and exhibits a greater motivation to connect with other people beyond those in one's primary relationships (Miller, "What do we mean": 2)

All of these qualities share the characteristics of a mutually empathic and growth-fostering relationship with others and the culture at large.

However, at its roots RCT is still a feminist theory. It was initially developed in order to reorient the concepts of the growth and development of women, although it may include a better conceptualization of the development and growth of men, it was developed to assist women in combating incongruent labeling and stigmas.

This type of labeling and stigmatization may also affect females more strongly than males. If is posited that females are more relationship-oriented, they may be more sensitive to the opinions of others and more vulnerable to negative labels. They may also be more sensitive to the perceived costs of labeling, such as disassociation from others and from society at large.. Such gender differences are taken into Account in the world of RCT and the reflected appraisals are certainly more correctly oriented to fit the female psyche. (Mcphail)

The true source of the core assumptions is the concept that all growth, development, personal evolution and occurs in connection with others and one's culture. It is more that then, this is viewed as a universal desire to be connected as well, to be a social animal so to speak. RCT believes that everyone desires growth and that growth is by necessity connective in relational and cultural links. Mutual empathy and mutual empowerment foster these relationships in positive ways. (Jordan, "The role of mutual")

Sigmund Freud and Erik Erickson may arguably be two of the most influential icons in the field of human development and psychology. Their fundamental concept that human's develop over a lifetime and not just in a few stages from birth to adolescence and then are frozen into psychological patterns, revolutionized thinking in the field of developmental psychology. The term Life Span Development came to the fore as Erickson devised his eight stages of psychosocial development ranging from birth to eighty years old. Later as he himself passed eighty he realized that there is yet another stage and the count became nine. (Erikson & Erikson, 1997) One can see the striking resemblance between Erickson and Freud's stages especially in Erickson's stages one through four as they almost mirror Freud's psychosexual stages exactly.