Look For A Symptom

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

Someday slow down …

and slowly

see how it takes a run

soul…

Behind every symptom

you can see the shadow of a significant person

I will share some of my professional discoveries concerning the peculiarities of the psychotherapist's perception of the client. The psychotherapist, in the process of his professional perception, needs to train the ability to see what is hidden behind the externally manifested phenomenon in the client: reaction, behavior, psychosomatic symptom, and sometimes even a character trait.

This is the essence of the psychotherapeutic position, which distinguishes it from the position of the layman, fixed on the "literal reading" of the phenomenon. Everyday non-professional thinking is always evaluative. It is based on moral, normative guidelines, polar in essence: good-bad, good-evil, black-white, normal-abnormal, etc.

The evaluative position does not allow seeing a person in many ways, it “grasps” some of the most prominent, at first glance, a feature, and reduces the entire personality to this feature. The appraisal attitude can also be present in the sphere of professional consciousness. An example of a professional evaluative position is the attitude to look at the client through the prism of diagnosis. The diagnosis reduces a person's personality, drives him into the Procrustean bed of a professionally accepted template. Even a typological diagnosis (not to mention symptomatic) reduces the variety of individual manifestations of a person to a stereotypical type-image.

In this regard, the words of Otto Rank sound convincing, asserting that each client forces us to reconsider the entire psychopathology.

The evaluative and diagnostic position mainly appeals to thinking and knowledge.

The psychotherapeutic position assumes a non-judgmental perception of the client. The psychotherapist, in his non-evaluative, accepting position, goes beyond the level of moral-normative evaluative thinking. Here, it is not the assessment that comes to the fore, but the attitude. The therapeutic position, based on attitude, appeals not only and not so much to thinking, but to feelings, intuition, and experience. The main professional tools here are the personality of the psychotherapist, his experience, sensitivity, intuition…. And as a method empathy or empathic listening is used, which allows, in the words of Irwin Yalom, "to look at the world through the client's window." Attitude, in contrast to assessment, allows you to see the personality of the client in many ways. Evaluation reduces the perceived person to a specific quality (hot-tempered, selfish, aggressive, etc.). In the process of teaching therapy, future therapists develop sensitivity to the client, focus on the need to search for several feelings towards him, which avoids one-sidedness and partiality.

A non-judgmental position makes it possible to see another person holistically and deeply, to look behind the facade of visible manifestations, which creates conditions for his understanding and acceptance.

Prince Myshkin from the novel "The Idiot" by F. M. Dostoevsky. His tragedy was that he was a therapist in real human relationships that did not function according to therapeutic rules. On the one hand, his sincere, authentic, accepting attitude towards people allowed him to look behind the facade of their stereotypical images, to expose their true motives and intentions in them, on the other hand, it made him vulnerable, defenseless in relations with others.

The therapeutic position does not work well outside the professional framework. In this regard, one of the psychotherapeutic rules is the rule not to work with loved ones.

The use of a non-judgmental therapeutic position is problematic in close relationships, primarily due to the short psychological distance, due to which the intensity of feelings increases and it becomes difficult to control them. In such a relationship, it is almost impossible to maintain a neutral, non-included, non-judgmental position. Secondly, the psychotherapist does not have the necessary professional authority for close people, regardless of his real status and professionalism.

The psychotherapist, on the other hand, as a professional (identified and accepted by others as such) is “protected” in his therapeutic position. This security is ensured by his status, respect for him, professionalism, and expectation of clients.

The professional therapist considers the problem phenomena-manifestations-traits of the client that fall into the psychotherapeutic field as a symptom, but at the same time he does not remain at the level of superficial perception of the symptom, but goes deeper, behind the symptom, trying to see what is behind it. In this article, a symptom is considered in a broad sense - as any phenomenon that gives a person himself or his environment inconvenience, tension, pain. In this case, a symptom can be understood not only as somatic, psychosomatic, mental symptoms, but also behavioral symptoms. The idea of a symptom as a complex, systemic phenomenon allows the therapist to reveal its original essence. A symptom is a sign, a sign of something. The whole symptom is woven from contradictions, paradoxes. He is hiding something, hiding and at the same time signaling about it. A symptom is a message that at the same time masks something else, which at the moment is impossible for a person to realize and experience. A symptom is a phantom behind which some reality is hiding, hiding, and a symptom at the same time is a part of this reality, its marker.

With the help of a symptom, a person defends himself - he hides or attacks. Someone "chooses" for themselves the tactics of hiding - goes into illness, apathy, depression, boredom, arrogance, pride … Someone defends himself, attacking - becomes aggressive, irritable, delinquent. The choice of response tactics, in my opinion, is determined by the presence of the installation of internality-externality according to K. G. Jung. External clients have a tendency to react, an external manifestation of the problem, for them the behavioral manifestations of a psychological problem will be typical. While internals tend to drive her inward, they are more likely to resort to bodily control or to experience her.

It is much easier to understand and accept somatic or even mental symptoms. In this case, it is easier for a person to do this, since such symptoms are often accompanied by pain (physical or mental) and it is easy for such a person to sympathize and empathize. The situation is more complicated with behavioral symptoms - reaction, deviant, delinquent behavior. It is in such situations that it is difficult to maintain a therapeutic position and look beyond the symptom, not to move into an evaluating, condemning, pedagogical position.

What resources should a psychotherapist have in order to remain in a professional position?

In my opinion, the most important thing here is understanding. The therapist's understanding of both the essence of the therapeutic process and the essence of those processes that occur with the client's personality in therapy. In the same way, adults, psychologically, not physically, parents can remain in an adult position in relation to the child, not sinking to the level of response when he goes beyond the expected behavior of adults. Smart adult parents understand that they have a child in front of them, that he is different - not an adult, and besides, they also had such a childhood experience. (By the way, what has been said does not apply to parents who were not accepted and understood in childhood). Likewise, "former" alcoholics "leading AA groups are able to understand those addicts who decide to get rid of her - they do not need to read in books about the emotional experiences of such clients - they know all this from the inside, from their own experience.

The foregoing does not mean at all that the psychotherapist must face and experience all the problems and traumas with which clients will come to him in order to learn to understand them. For this, the therapist, in the learning process, undergoes obligatory personal therapy, which increases his sensitivity to himself and, as a consequence, to the Other.

Who / what is the client protected from by resorting to a symptomatic response?

As a rule, from people close to him, who could not understand, accept, share, regret … From pain, despair, rage, melancholy, arising from such an inability of the other to be around.

Example: A client speaks with great anger about the situation in her extended family. Her daughter-in-law, who is currently on parental leave, wants to move to another city, where she was offered a good job. She speaks negatively about her daughter-in-law's decision in every possible way. She accuses and reproaches her that she does not think at all about her family, a small child, her husband - she acts extremely selfishly and thoughtlessly. Declares that she will not allow this. The therapeutic reaction that she is trying to interfere in the life of a young family, the client has even more indignation and a rational explanation of why she is doing this. This therapeutic response is directed towards a directly demonstrated phenomenon. The result is increased defenses. The therapist notices that he sees the client's caring attitude towards this issue, that something very strongly includes her, as if there is something else behind it, which makes her so indifferent. Long pause during which the client stops her angry speech and starts crying. After tears, she begins to say that she is hurt and scared for a small child, tells the story of how her parents, busy with studies, “floated” to the village to her grandmother at the age of one to four years, with bitterness and pain speaks of how her mother visited her only for the weekend. This therapeutic reaction is directed "behind" the externally manifested phenomenon, on what is behind it, what feeds it and gives it energy.

Who is he attacking and why?

As a rule, again most often on people close to him. To get attention, get cared for, or distance yourself from them. And he does it all from the same pain, despair, rage, longing, to people who do not notice, ignore, devalue, hold back …

Example: I recall an episode from Nikita Mikhalkov's film "12". One of the jurors (actor Makovetsky), doubting the guilt of the defendant, tells his life story. He, a junior researcher at a research institute who works for a pittance, made a discovery for which he was praised at the institute, given a prize - as much as 50 rubles - and offered to do something else. He brought home the result of his four-year work - 50 rubles. One large Western firm offered him a lot of money for his opening, but he, being a patriot, refused. He went to different authorities, everyone said “Yes, this is great!”, But they refused. He started drinking. He lost his job, his wife left him … Then his monologue: “… but nothing mattered to me, only the drink - from morning to night … Once I felt that I would soon die. And you know, I was even delighted with this thought. I only wanted one thing - as soon as possible. I began to seek death. I fought with the police, pestered neighbors, beat me, cut me, I spent the night in the doorways, I was lying in hospitals. They beat me bloody - nothing … Once I was driving an electric train, ugly drunk, dirty, smelly and pestered passengers, yelled, swore … I looked at myself from the side and rejoiced at my abomination! And I dreamed of only one thing, that there would be at least one person who would take me and throw me out of the train at full speed, so much so that my brains on the rails to smithereens. And everyone sat and said nothing, were silent and averted their eyes. Except for one woman who was traveling with a child of about five years old. I heard the girl say: "Mom, my uncle is crazy, I'm afraid of him." And this woman answered her: "No, he is not crazy, he just feels very bad."

… I sold my technology to a Western company, it works now in every second mobile phone, and I am a representative of this company. This woman is now my wife, the girl is my daughter. I should have died under the fence, but I didn't, because one person, one, treated me more attentively than everyone else. "

Behind each symptom you can see the shadow of a loved one, each symptom denotes the fact of a failed meeting, an unmet need. The symptom is always a "borderline" phenomenon, it arises on the "boundary of the relationship", marks the tension of contact with another. One cannot but agree with Harry Sullivan, who argued that all psychopathology is interpersonal. And psychotherapy, therefore, is interpersonal both in its aims and in its means.

When we undertake work to reveal the essence of a symptom, it is necessary, first of all, to actualize its influence on others: How does it feel? To whom is it addressed? How does it affect the other? What does he want to "say" to the other? How does he mobilize a response?

What can we see by looking behind a symptom?

A feeling that is difficult to comprehend, accept, experience at the moment.

Need - unconscious, unacceptable, rejected.

Apathy can hide suppressed interest, depression - rage, anger - love, anxiety - fear, arrogance - fear-desire for intimacy …

Behind the outwardly demonstrated symptoms-manifestations-features, the psychotherapist, no matter how pathetic it sounds, tries to examine the human soul, its aspirations, experiences, disappointments, expectations, hopes … A soul turned to another, thirsting for understanding, sympathy, love.

For nonresidents, it is possible to consult and supervise via Skype.

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