Focuses And Perspectives Of Work With A Psychogenic Symptom

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Focuses and perspectives of work with psychogenic symptom

The phenomenological method allows you to "turn" a symptom into a phenomenon and return a person's individuality to therapy

I share my experience with the symptom. For professionals.

In this article I want to describe the specifics of working with clients who present their problem in therapy as a symptom.

Psychogenic symptom and its manifestations

The client turns to a psychotherapist with his problem. The client's vision of the problem, as a rule, boils down to listing a number of symptoms-complaints noticed for him, 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 interfere with his full life, cause unpleasant, often painful sensations and experiences.

However, if the therapist adheres to a similar position in his work, then this will not allow him to understand the essence of the client's problem and, at best, with the help of psychotherapy 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 like a phoenix.

In this case, we will not be limited to symptoms of a psychosomatic nature, since the term "psychosomatic" does not describe the entire spectrum of manifestations of psychogenic symptoms. I use the term psychogenic symptom, taking as a basis the factor of causality. The term "psychogenic" indicates mental causation. The cause is psychotraumatic factors (PTF) - trauma, stress, conflicts, crises.

The consequences of PTF can manifest themselves in different areas - mental, somatic, and behavioral. In this regard, we can talk about the symptoms of mental, somatic and behavioral, marking the client's problems. The criterion for determining such a symptom will be the cause of its occurrence - psychogenic etiology.

Mental symptoms are manifested in abnormalities in the mental sphere and are associated with those inconveniences that they cause, for example, phobias, obsessions, anxiety, apathy, depression, guilt, etc.

Somatic symptoms are most often manifested in complaints of pain in the bodily organs or somatic dysfunctions. It is important to distinguish them from similar symptoms of non-psychogenic etiology.

Behavioral symptoms are manifested by various deviations in the client's behavior and interfere to a greater extent not with the client himself, but with other people. For this reason, most often it is not the client himself who turns to the specialist, but his relatives with a request “to do something with him …”. Examples of this kind of symptoms are aggression, hyperactivity, deviance, and delinquency.

Focuses and perspectives on symptom management

In working with a psychogenic symptom, it is necessary to single out several focuses that determine the perspective of a psychotherapist's work. Here I highlight the following perspectives: actual, historical and futuristic. As a rule, work with a symptom begins from an actual perspective and further represents "shuttles" into the historical and the futuristic. I will dwell in more detail on the content of the work in the selected perspectives.

Actual perspective - this is work in the "here and now". The main question here is: How and What?

How does the symptom manifest? What is he? How is life with the symptom?

In actual symptom research, we ask the client many clarifying questions: "How do you feel?", "Where?", "What is it like?" talk? "," What is he silent about? " etc.

This is a phenomenological focus of research into the essence of a symptom. Its main task for both the therapist and the client is to turn the symptom into a phenomenon.

Here are some techniques for the phenomenological study of a symptom:

"Symptom as Image"

We ask the client to focus on the symptom, pain, fear, etc., depending on the problem. We ask questions that allow us to present the symptom as a specific image. For example:

- Where is it felt inside you?

- Where exactly in the body is the symptom localized?

- What colour is he? What shape? What texture? What is the temperature?

We strive to ensure that the symptom can be presented in the form of a specific image.

We ask the client to imagine that the symptom left the body and became a separate object.

We suggest placing it on a chair in front of you and for fixing it, ask to describe it in all modalities, asking the questions from the previous step, with the exception of clarifications on bodily localization.

"Getting to know the symptom"

Draw your symptom. Identify with him. Come up with a story on his behalf:

What does the symptom want to tell you? What is the symptom silent about? If he could speak, what would he talk about?

- Who is he?

- What is he?

- What's his name?

- What is he for?

- What is its use?

- What feelings does he express?

- To whom?

- What does he need?

- What is he missing?

- What does he warn against?

Historical perspective - this is work in "there and then". Key research questions here are: When? Why?

When did the symptom first appear? What happened at that moment in the client's life? What kind of people were around the client? What events were taking place at that moment?

A symptom is not just some abstract symptom - it is a symptom of a specific person and it is woven into his life story. Therefore, if you want to unravel the mystery of a symptom, you will have to investigate its history, closely intertwined with the client's life story, and face a number of interesting facts. Namely:

- He has an individual history of occurrence (time, place, situation).

- It has a reason for its appearance - for some reason?

- In the course of the life of a symptom, it begins to "grow" with additional meanings - secondary benefits that give meaning, both for the bearer of the symptom and for his immediate environment.

With a phenomenological approach, a symptom ceases to be just a "sign of something." Viewed through the prism of personality, it becomes a part of the personality, its history. Only after studying and understanding the essence and meaning of a symptom for a person, his personal history, can one count on the possibility of replacing it with higher quality forms of life. Otherwise (with a symptomatic approach), in place of the removed symptom in the personality structure, there remains a gap that the personality, as a system, will have to fill with something. Typically a different symptom, but more destructive to the individual.

The following techniques can be used at this stage:

"History of your illness"

Remember the features of the life period that you experienced immediately before the onset of the disease.

1. Identify in your past three to six times when you have:

a) there was a periodically recurring and haunting you "acute" illness;

b) there was an exacerbation of the chronic disease.

2. Now, starting with the very first case, proceed to fill in the following table. The answers should be long enough.

This technique allows, firstly, to identify the cycles and pitfalls of your life. The life of any person consists of certain cycles that occur at regular intervals. Within each cycle, we solve certain types of problems by learning some new life skills. But if the problems of the cycle are not resolved, and we are not learning what we should have learned, a trap arises, and the same problem will recur in our lives over and over again, preventing us from moving on.

In the overwhelming majority of cases, the disease is precisely the result of such a trap, an unfinished cycle, or the result of untapped skills.

Secondly, points 3 and 4 of the above table are intended so that you understand what you learned there and then (or what you should have learned) and determine what was (or should have been) the value of the experience, which, according to - apparently, until now it remains not mastered by you.

Futuristic (existential) perspective - it is a symptom-oriented work towards the future. A symptom has not only a meaning, but also a meaning - did it appear for something, for some reason?

The main questions here are: Why? For what?

In exploring the existential perspective of the symptom, we ask the following questions:

- Why does the client need his symptom?

- What is he distracting him from?

- How will his life change without a symptom?

The following techniques can be used at this stage:

"Life without a symptom"

Imagine waking up and finding out that the symptom has disappeared. How would you live this day? What would you do? How would you feel? What would you be missing?

"Determination of the meanings and benefits of the disease"

In this technique, it is proposed to ask the client questions or ask him on his own, alone with himself, to answer the following questions as honestly as possible regarding his symptom. The task of the exercise is to translate the mental aspects of the disease into the plane of “meanings and needs”.

1. What does the symptom mean to you?

2. What does it mean for you to get rid of the symptom?

3. How does the symptom help you, what benefits and compensation do you get from it?

4. How does a symptom give you more strength and confidence?

5. How does the symptom make you feel safe?

6. What does the symptom help you avoid?

7. How does the symptom enable you to receive more attention and love?

8. What were you like before the symptom appeared?

9. How did things change after the symptom appeared?

10. What happens when there is no symptom?

11. After the symptom disappears, what will your life be like in a year (in 5, 10, 20 years)?

"The symbolic meaning of a symptom"

1. What does not allow me to do symptom?

The answer to this question will determine which ones are blocked.

2. What does the symptom compel me to do?

Start each answer to this question with the negative particle "not" and find out which desires are blocked.

3. If I allowed myself to realize these desires, how would my life change?"

The answer to this question determines the deepest need of your being, blocked by some false belief.

4. "If I allowed myself to be … (insert the answer to the previous question here), what terrible or unacceptable would happen in my life?"

The answer to this question will allow you to identify the beliefs that are blocking you, your desires and your need for self-realization, thus creating a problem.

Try to imagine how else you can achieve the same as the symptom gives you.

At the existential stage, it is also necessary, together with the client, to look for new ways of contacting the world, without resorting to the symptomatic way, and to master these new ways.

The symptom shifts the focus of the client's attention from his psychological problem (problems of relations with oneself, the Other, the World) to himself. As a result, the client receives a temporary relaxation of anxiety - it goes from acute to chronic and ceases to be realized and experienced as a problem. On the periphery of consciousness, only undifferentiated anxiety remains.

The main questions to work with at this stage will be the following:

· How to learn to live without a symptom?

· How to fill the void formed at the site of the symptom?

· How to replace it?

It is important, before giving up a symptom, to find and master another, more effective way of life, more productive forms of contact with the world, others and with oneself. Before you take crutches from a person, you need to teach him how to do without them.

Otherwise, the client, deprived of the usual, symptomatic forms of life, turns out to be disintegrated and confused. At this stage, therapeutic experimentation becomes appropriate, allowing the client to meet and experience new experiences and assimilate them into their new identity.