A SYSTEMIC VIEW OF SYMPTOM

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A SYSTEMIC VIEW OF SYMPTOM
A SYSTEMIC VIEW OF SYMPTOM
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SYSTEM APPROACH TO WORKING WITH A SYMPTOM

A symptom is evidence.

Therefore, removing the symptom, we remove evidence

Sometimes the roots of the symptom

go deep into family and even

generic layers of the human psyche

What is the symptom? What are the symptoms? What is the difference between a symptom and a phenomenon? What principles should be followed when working with a symptom? What is the essence of the diagnostic stage in working with a symptom?

What systems can the symptom under consideration be a part of? How to determine within which system a symptom should be considered? This is what my article is about.

To begin with, it is important to determine the research paradigm, the basis without which professional work is impossible. Since any phenomenon of reality can be viewed from different angles, the view of the symptom also changes depending on the focus of its consideration.

I adhere to two principles in my work with a symptom - phenomenological and systemic, allowing you to look at the symptom not as a separate element of reality, but as an integral, systemic phenomenon.

The client turns to the therapist with his problem. His (client's) vision of the problem, as a rule, boils down to listing a number of symptoms-complaints that he noticed, which do not fit into his idea of "how it should be" and the desire to "fix it in the course of psychotherapy."

The client's position in the desire to get rid of the symptom is understandable: the symptoms of his problem interfere with his full life, cause unpleasant, often painful sensations and experiences. However, if the therapist adheres to a similar position in his work, this will not allow him to understand the essence of the client's problem and, at best, with the help of therapy, it will be possible to remove the symptoms, but not to solve his problem. The symptom, having temporarily disappeared, will again and again be reborn as the Phoenix bird.

In this case, I will not be limited only to symptoms of a somatic nature, we will talk about an expanded view of a symptom as a single sign that marks a problem.

Symptom (from ΣύΜπτοΜα - coincidence, sign) - one of the individual signs, the manifestation of any disease of a pathological condition or a violation of any process of vital activity.

In this regard, we can talk about the symptoms of mental, somatic and behavioral, marking the problems of the named levels of the client's existence.

In addition, symptoms in the clinic are traditionally divided into objective and subjective. The combination of these symptoms gives us a clinical picture of the disease. But here a certain difficulty arises in the diagnosis - the doctor "notices" mostly objective symptoms, the patient, in turn, focuses more on subjective symptoms. The psychologist in his work also focuses on subjective symptoms. Such a specific professional perception, in both cases, leads to a symptomatic, one-sided perception of the problem, which does not allow seeing the phenomenon as a whole.

The words "phenomenon" and "symptom" are often used interchangeably. Meanwhile, the word "phenomenon", on the one hand, vividly, expressively expresses the unique individuality, specialness, rarity of the subject of description, and on the other hand, it implies something integral, structurally complete in itself. A phenomenon is a fact of consciousness. Whereas the word "symptom", defined by all as "sign", is a particular touch in the picture of the whole.

Therefore, a symptom is not equal to a phenomenon. The phenomenon is broader and deeper than the symptom. In addition to the meaningful meaning of the symptom, the phenomenon contains its “experiential” meaning for the client.

Why do we need a phenomenological approach? What does he give us?

We, as researchers, can only observe external manifestations, markers of phenomena - symptoms. And here it is important to remember that they do not reflect the whole essence of the phenomenon. In order to get a more holistic view of the client's problem, we need to have access to internal phenomena as well. For this, psychotherapy uses empathy and identification, empathy, immersion in the inner world of another.

We carefully examine the symptom, referring to its perception-experience of the client. Any methods of "acquaintance" are appropriate here - from verbal - "Tell, describe", to non-verbal - "Draw, blind, depict your symptom." For a fuller and deeper perception by the client of his symptom, one can resort to the technique of identifying the client with his symptom - “Stay with your symptom”, “Compose a story on behalf of your symptom: Who is he? What for? What does he want? From whom? etc.

The therapist's attentive appeal to the client's description and experience of his subjective symptoms allows them to “transform” them into phenomena, to create a more holistic picture of his problem.

An objective, symptomatic approach allows us to see only the superficial level of the phenomenon, without its content (phenomenological experiential content) and meaning. The phenomenological approach allows a more holistic study of the phenomenon, its not only external, but also internal, experiential aspects.

However, in my opinion, only the phenomenological principle in diagnosing a client's problem is not enough. The phenomenological principle in diagnostics must be supplemented with a systemic principle.

Why do we need a systemic principle?

The phenomenological principle allows the therapist to create a complex, holistic, individual representation of the manifestation and experience of the client's problem, to understand its subjective meaning, but does not allow to see its essence. To do this, we need to go beyond the client's subjective perception of the phenomenon.

If the phenomenological principle allows us to better understand the essence of the phenomenon, then the systemic principle allows us to expand its context, to consider the client's problem not as an isolated symptom, or even a phenomenon, but as part of something larger, included in a higher-level system, to see it not as a separate one, an independent element, and its place in the system to which it belongs, how does it live in this system, why does it need it?

A systematic view of a symptom allows one to move from "Surgical installation" to the essence of the symptom ("a symptom as something alien, unnecessary for the system and, therefore, it is necessary to get rid of it") to holistic view on its role, functions and essence, its outwardly invisible and unconscious need for the system. It allows you to answer not only the question “Why did it arise?”, But also “For what? Why does this system need it at this moment in life? "," What system load does it carry "," What function does it perform?"

Possibilities of using systemic and phenomenological principles

Consistent use of phenomenological and systemic principles in working with a symptom makes it possible to look at a symptom from different perspectives - near and far, then plunging into it, then taking a metaposition. Thanks to phenomenology, we can consider the subjective component of the symptom, the personal, individual that each person brings to the symptom. The systemic view allows one to see a symptom not as a separate phenomenon, but as included in systemic connections, its place and function in the system of which it is a part.

Thus, in working with a client, we need to use both phenomenological and systemic principles. Using these principles in work allows you to go both in depth and see what is behind the symptom. Here, in my opinion, a metaphor with an investigation would be appropriate: A symptom is evidence. Therefore, when we take a symptom, we remove evidence. Our task is not to remove the evidence-symptom, but to understand the essence of the evidence-symptom, to detect and read its message.

How it works?

We first rely on phenomenological principle. We, as researchers, study in detail all the manifestations of the phenomenon-problem, its external and internal signs-symptoms. To do this, we ask the client many clarifying questions: "How do you feel it?" "," What is he silent about? " etc.

Further, we are trying to understand-determine the belonging of a symptom to any system, an element of which system is it, the needs of which of them does it satisfy? A symptom can be considered as an element of the personality system, the family system, the generic system (more on this later). Here we ask ourselves and the client the following questions: “Why does this system need a symptom? What system function does it perform? What systemic need is met by a symptom? What is its positive significance for this system?"

Then we have a hypothesis that explains the essence of the observed phenomenon, its role and function for the system within which it lives. This is already a systemic stage. … And then we make shuttles: from the systemic to the phenomenological and vice versa, testing and refining the hypothesis.

In diagnosing a client's problem, we go in the following sequence: SYMPTOM - PHENOMENON - PROBLEM.

The client is a part of a system, he is certainly included in system connections and his problem, presented as a symptom, must be considered in a broader context. Only in this case can we “get to the bottom of it”, understand its essence and deprive it of energy. At the same time, a symptom as a systemic phenomenon may, in my opinion, be an element of the following systems:

A) "personality" systems;

B) the family system;

C) generic system or metasystem

How to determine which system a symptom is part of?

Symptom as a phenomenon of the "personality" system

In my opinion, there are two criteria that allow us to consider the client's symptom within the framework of the personality system:

  1. When we observe sufficient autonomy of the client from his family system (extended parental or nuclear). The client is not prone to mergers, dependencies, but functions as a separate, autonomous system. At the same time, he can be included in other systems, primarily the family one, but with clear functions and roles, stable boundaries and a clear awareness of the boundaries of his responsibility in relation to other members of the system, of which he is a part.
  2. As part of the study of the client's life history, it is possible to find traumatic events that explain the possibility of the appearance of a symptom-problem (mental trauma, developmental trauma).

An example of a symptom as a phenomenon of the "personality" system:

The client, a 32-year-old woman, made a request for lack of sex drive to her husband. Later, in the course of therapy, it became clear that, in principle, she was not sexually attracted. Anything related to this topic causes a strong disgust in the client. Similar reactions were observed in her and in relation to men who showed sexual interest in her. In the course of researching her personal history, the fact of her father's sexual intimacy with the client's best friend came to mind. Due to strong intense feelings (disgust, shame, rage) she failed to survive this event in due time. History “erased” from memory by splitting off the part “I am a sexy woman” from the image of my Self. When there was such a "danger" of meeting this rejected part, the client developed strong disgust.

In the cases under consideration, we can observe the existence in the client's identity of some alienated, unacceptable aspects of his Self. At the same time, we can talk about insufficient differentiation and integrity of the Self.

Symptom as a phenomenon of the family system

However, it is not always possible to explain the cause of the client's symptom based on his personal history. Sometimes, having investigated the history of the client's symptom-problem in therapy, you understand that everything in his personal history is more or less successful, and those traumatic events that he still has (and who does not?) "Do not pull" on such a problem … In this case, we can assume that the symptom is a phenomenon of a system of a more global level than a personality. Then we consider the hypothesis of the emergence and existence of a symptom as a phenomenon of the "family" system.

The criterion for making such an assumption may be the client's psychological autonomy / dependence.

If we see that the client is in a dependent relationship with the family parenting system (age does not matter here, but this rule applies to children unambiguously), then we need to consider his symptom as a family systemic symptom, and the client as an identified patient (a term specifically used for such a phenomenon in systemic family therapy).

We can assume that the client's symptom is a family system phenomenon in the following ways:

  • the client easily switches from the topic of the symptom to the topic of family relationships in the conversation with the therapist;
  • he has strong emotional ties with other family members;
  • despite the education of his family, the client continues to consider himself part of an extended family.

Examples of a symptom-problem as a systemic phenomenon:

A young woman came in for chronic stomach pain. A thorough examination by doctors did not reveal any somatic pathology in her. The client already showed strong emotional ties with the extended parental family at the first meeting. Despite the fact that she has been married for 5 years, at my request to arrange her family members with the help of figures, she, without hesitation, put not only her parents, but also her sister with her husband and child. The conversation soon switched from a symptom to her strong rescue tendency. The client does not live her own life and the life of her new family, she tries to actively solve the problems of her mother, sister, and includes her husband in this. The marriage, which is not surprising, hangs in the balance, the relationship with her husband is strained, but for her the parental family system is more important.

We can see both variants of merging in the dyad (mother-child, husband-wife), and within the extended family system (daughter-mother, son-mother, daughter-father). The most striking phenomena that mark the merging of the client with other members of the family system are triangulation and parentification.

Triangulation is the emotional involvement of a child with marriage partners in order to solve their personal problems.

Parentalization is a family situation in which a child is forced to become an adult early and take custody of his parents. (More on these phenomena in the next article).

Symptom as a phenomenon of the generic system

Sometimes fusion can also be observed at the intergenerational level. In therapy, there are times when you begin to understand that the client's problem has deeper roots, goes beyond the scope of his current family. The threads of fusion stretch into the ancestral history.

Our ancestors donate to us, among other things, their unresolved development tasks. The mechanism for passing such tasks is the generic script. The relay of the symptom-problem is passed on to the family member with whom there is an emotional merger. Within the framework of the family constellation method, this phenomenon is called entanglement. A mandatory attribute - a marker of such a merge-weave is the presence of family secrets in the system. (In the book by Natalya Olifirovich "Family secrets: you cannot keep it open", the mechanisms of their functioning are described). Mystery is a place where there is no clarity. And where there is no clarity, there are always conditions for merging, interweaving. This is how transgenerational links work …

Practical examples:

Client 30 years old, married. His marriage is assessed as successful. I got married for love. The husband is good - he loves her and their little daughter. Everything would be fine, but the client has some incomprehensible urge to leave her husband. The husband, according to the client, behaves impeccably, does not give her a reason to break off relations. In the course of therapy, the client realizes that men are not held in her family. Women in this family are all strong and lonely. The life scenario for all women is similar: a woman marries for love, gives birth to a girl, after a while the husband is “expelled” from the family under various pretexts, and as a result, the woman brings up the girl herself. The girl grows up and…. all repeats. One gets the impression of some kind of "female conspiracy" - as if a man is needed only to conceive a child …

One more example:

A client, 42 le, teacher, asks for a dependent relationship with an adult daughter.

When therapy, after multiple attempts to “let go of the daughter,” once again comes to a standstill, I understand that it is necessary to change the focus.

I ask the client: "Do you have a man now?" Answer: “No. There was a husband, but they divorced a long time ago. " I start asking about her life after the divorce and about her relationships with other men. Yes, there were men in her life, but … one did not fit because she was afraid that her daughter would not accept him, the second earned little, the third had bad habits, the fourth … The client listed all the men in great detail, explaining why each of them to her did not fit. At the present time, no explanation is required at all: “Why are they needed? And you can live without them!"

I am interested in men of her kind. The mother lived alone, the husband in the process of life "turned out" to be a drunkard, and was expelled from the family, the grandmother also raised the client's mother alone, her husband left the family. When it came to her great-grandmother, the client recalled a family legend: her great-grandmother loved a young man, but at the insistence of her mother, she was forced to marry another, unloved person. Life without love was not sweet for her. Children-girls were born … Vera, Nadezhda, Love! The last daughter, Love, as the family history says, was born not from her husband, but from her beloved great-grandmother. Nobody spoke about this openly, but “everyone knew and kept silent,” they preferred not to talk about it as some kind of family secret.

I suggested that it is possible that women of her kind are in a psychological connection-merging with her great-grandmother, and her difficult life in a marriage without love. As a consequence, they remain loyal to her and follow her, choosing her such a fate. (You can read about this in more detail from the author of family systemic constellations, Bert Hellinger). The relay race in this family is passed from generation to generation along the female line - from mother to daughter. Now my client has adopted it, unconsciously adopting the generic setting: "Mom, I am the same as you, I will live like you, without a man next to me, I will not betray you!"

In this case, men turn out to be unnecessary, they interfere with the embodiment of such a female scenario. Therefore, they need to be “removed” from the family. Our consciousness works in a very sophisticated way and can find many different ways to protect and justify unconscious attitudes. In this case, women find some unsuitable qualities in men - and who, tell me, is ideal? As a result, such an unsuitable man "is declared a goat, a bastard …" and is expelled from the family.

The generic level male-hatred virus in such families is also reinforced at the level of individual life history. A girl infected with such family attitudes and trapped in the birthing script encounters the real trauma of being abandoned by her father and reinfects with a negative attitude towards men. The circle is closed. Our heroine is ready to pass on the baton of the family scenario further - to her daughter.

These are examples of problems due to generic scenarios that go far beyond the individual life of a person and in order for such a scenario to recognize and detect and work out the roots of the problem, a thorough study of the generic history of the family system is necessary.

Thus, we can conclude that

  • symptom-problem must be considered as a phenomenon of systems of different levels: personality, family, clan;
  • The belonging of a symptom-problem to a system of one level or another is determined by the degree of dependence - the client's autonomy from it. The client's lack of autonomy from the parental family includes him as an element in a broader system - the family system, sometimes going deep into the intergenerational strata. And his problem-symptoms in this case must be considered within the framework of this system in order to understand - why are they? To be continued….

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