The psychotherapist moves away from his consultation. Encounter, interaction and complementarity are seen from the Existential Analysis and Logotherapy.

 Original book published in Spanish by Amazon Books. Paper version and e-book

 

Dr José Martínez-Romero Gandos

August 2022.

 ABSTRACT

A different way of psychotherapeutic consultation through the presence of the therapist outside of his habitual office and the encounter with the patient in his particular circumstance to provide different ways of approaching reality.  The experience works to open to new meanings in the relationship with one atmosphere of commitment.

KEYWORDS: consultation, encounter, existential psychotherapy, logotherapy, external psychotherapy.

 

CURRENT PROFESSIONAL ACTIVITY

Psychologist (U.B.A). PhD in Psychology (USAL Argentina and University of Corunna, Spain). Former Director of the Psychology Career at the USAL. Member of societies of Logotherapy and Existential Analysis

POSTAL ADDRESS

Dr José Martínez-Romero Gandos

Rúa dos Osos, 8   3º A

C.P. 15142 – ARTEIXO

Pcia. de A Coruña – Spain

jmrsentido@gmail.com

 

 INTRODUCTION

            In this paper, we will try to explain our experience in assisting patients who consult a psychologist. In the course of these interactions, after the professional adjusts his diagnosis, prognosis and treatment, we will show that the continuity of these "encounters" was not always carried out in "consultation" in the usual work of the professional.

           These concepts will not only help trained professionals but also solve the needs and the doubts of young graduates of the Faculties of Psychology, in any corner of the planet, who put their motivation and professional work to start attending the other according to the canons obtained in their training and the respect for the laws and general provisions in each community.

           They have had internships in that training. Now, they should be oriented to the search for a position in the official health activity, in a private clinic or open their private consultation.

Etymologically, the term "consultation" derives from the Latin "consulere" (Unus peritus, si necesse est, consuli possunt. An expert, if necessary, can be consulted.) We express this "valetudini consulens" as "health consultation".

           When a person goes to a psychologist we also talk about "consultation." The consultation is the time in which the patient is next to the professional in a certain space (the office), while the professional gives his opinion and recommends the steps to follow.

            But does everything have to happen in a certain space? It will be controversial but we can say "not always".

           We will try to explain our experience in assisting patients who consult a psychologist. In the course of these interactions, after the professional adjusts his diagnosis, prognosis and treatment, we will show that the continuity of these "encounters" was not always carried out in "consultation" in the usual work of the professional.

            We describe the psychotherapeutic process as a series of meetings in which who is attending a psychologist provides a controversial situation of his existence that he must confront with his reality. In the consultation, he or she will look for answers that will arise in the therapeutic relationship by providing a different vision and projection of those situations. In these confrontational situations, it is possible that on many occasions we can disagree, and where we examine together the diverse and divergent ways that we have to give new meanings to these issues and to experience the issues on which we reflect together. The existential-phenomenological understanding that we seek underlines the differences of appreciation and experience of each one, just to keep us open to new meanings, and to be able to confront them attentively.

           The existential therapeutic encounters are far from being "relaxed moments", they are rather an atmosphere of alert attention to the construction of meanings, to inter-relational processes, and to how the existence unfolds through the shared analysis of experiences.

           Our style of psychotherapy is based on the analysis of the experience that is displayed moment by moment, through the therapeutic relationship. Viktor E. Frankl (1978, pg. 66) noted in his book The unheard cry for meaning. Psychotherapy and Humanism that “True encounter is a model of coexistence that is open to the logos, allowing the partners to transcend themselves toward the logos, and even promoting such mutual transcendence”. Promoting that "coexistence" and dialogue is how we are entering the world of another person. Being together connected always involves coexistence.

           The Existential Analysis and Logotherapy support an anthropological, philosophical and humanistic foundation that seeks to understand human existence based on the experience of psychotherapists, especially as regards the affective, historical, unique and unrepeatable level of each human being, valuing freedom of each of the members of the meeting to make elections. Choosing generates anguish, the anguish of existence in the face of the use of freedom. The anguish that is generated in each election because it reflects what we are going to achieve and forces us to take responsibility for it, whether the solution is positive or negative. In the case that we consider the choice to accept the surgical intervention, it resulted in post-operative success, the reduction of anxiety and fears, the modification of the attitude towards reality and the achievement of well-being.

           From the second half of the 20th century, we observe that the attitude in hospitalization services is changing and the staff encourages important changes in infrastructure and patient care. A current example: in a Hospital in Alicante, Spain, the rooms and halls of the Children's Oncology Service have recently been painted with ad-hoc drawings with the collaboration of local Arts students. Applause for the initiative. As well as applause by volunteers who "crochet" or make fun style bags to cover the serum bags of the children admitted.

           What matters is not only assistance at the biological level but also the corresponding psychological and social. In England, at the School of Psychotherapy, under the Direction of Emmy van Deurzen, a Master in non-religious “pastoral” care is offered in hospitals, prisons, schools and armed forces training psychologists in this type of care, which also includes, weddings, funerals or imposition of names, all from a secular and professional perspective. Emmy van Deurzen is a reference and a very authoritative voice in European academic training. His Master offers instruction in “non-religious pastoral care” that corresponds to the concept expressed by Frankl when he refers to the “medical cure of souls”. We quote Marta Guberman (2005, pg. 36) when she says: “The cure of medical souls is an attempt by the doctor to apply his art and technique while preserving the human character of the encounter. "The cure of medical souls" does not have to be confused with religion or psychotherapy, because it does not attempt the salvation of the soul as the first nor substitutes the second." (Original in Spanish)

           We talk about the encounter, coexistence, self-transcendence and psychotherapy as a process in which the consultant presents a series of conflicting situations that he must confront with his reality. The patient seeks answers and will find them in the therapeutic relationship that will provide a different view of these situations.

            We insist that the main issue of our work is to describe the professional work of the Psychologist who leaves your office to attend particularly. The Psychologist who "goes out" and acts outside his work office, is not a less qualified professional or violates any Code of Ethics as there is an obligation in all countries to seek the welfare of the applicant for assistance, which is the primary purpose of the profession.

           We mention here that psychotherapists can attend weddings, funerals, births or ad-hoc shows. What is the scientific evidence regarding these types of practices and about Existential Psychotherapy? Science has as its object of knowledge the man in his facticity (psychophysical dimension, historical, cultural and social environment). To which we add the spiritual dimension. Science can explain but cannot understand the meaning that transcends that immanence that it studies. Therefore, when treating Man, we value his being a unique and unrepeatable person, with the capacity for freedom, responsibility, meaning and values capable of interpreting the demands of life, affirming that it makes sense, despite everything.

            It may be pertinent that we now recall some concepts that may come close to the definition of Existential Psychotherapy that was developed between 2014 and 2016 by an international group of professionals grouped in the World Confederation of Existential Psychotherapies (2016), which represents a cross-section of contemporary existential therapists who, in a cooperative effort, wrote a well-founded definition that was published in the Latin American Journal of Existential Psychotherapy translated by us at the time.

            Our colleagues said: “… In any case, we can say that, although it is difficult to formalize and define, as we feel it, Existential Therapy is a profoundly philosophical approach characterized in practice by an emphasis on relatedness, spontaneity, flexibility, and freedom from rigid doctrine or dogma. Indeed, due to these core qualities, to many existential therapists, the attempt to define it seems contradictory to its very nature.”

           We wish to underline from this definition the concept of “spontaneity” and that of “flexibility”, both essential for a proposal like the one we are making here. It is not less, of course, the concept of "emphasis on the relationship." On this last concept, we have abundant bibliography.

           In general, among Existential Psychotherapists, we agree that psychotherapy is always more than a technique because it includes an element of art and is always more than a mere science insofar as it also includes an element of wisdom. In this sense, Art and Science form a unity and totality where the dichotomies between technique and encounter disappear and dissolve. In our clinical practice, we certainly use some techniques (Socratic dialogue, paradoxical intention, stop reflecting) and some intermediary elements (masks and puppets) to promote the relationship and the achievement of certain objectives without losing sight of the person. (Frankl 1988; Martínez-Romero Gandos J. 2011, 2016, 2017; Martínez Robles, Y. A. 2010)

           The definition of Existential Psychotherapy cited above (op cit. 2016) adds that: “… the therapeutic objective is to illuminate, clarify and place these problems in a broader perspective to promote clients' ability to recognize, accept and actively exercise his responsibility and freedom: choose how to be or act differently, if such change is desired or, if not, to tolerate, affirm and embrace the choice of his ways of being in the world.”

           And they insist, later: “… This technical flexibility allows some existential therapists the freedom to adapt to the particular response or intervention to the specific needs of the individual client and to the therapeutic process that is continually developing. However, regardless of whether or not to use methods in existential therapy, these are intentionally chosen to help illuminate the person's being at this particular moment in their history.”

 

CASES

For a better understanding of the cases attended outside the consultation, we present a table with the basic references. Then we will briefly expand the corresponding data.

 

FICTITIOUS NAME	HEALTHS ROBLEMS	APPROACH OUTSIDE OF PRACTICE
Peter – 35 years old	Phobic state - Inability to go outside or go to work.	He lived in a big city and worked in the most active commercial area. He complained that traffic congestion and people in the street at the time of entry to his work paralyzed him and did not dare to leave, with the consequent damage in the family environment. We talked several minutes to achieve a suitable climate and reassure it as far as possible and we propose to go out together. We leave the consultation and take a taxi. During the trip, we propose exercises. When we arrive, we insist on Pedro to get off the taxi, cross the avenue and enter his office. He refuses a little but finally trusts and does it.
Eduard – 18 years old	Teenage crisis - Affective dissociation, disharmony in the development and ambivalence of feelings. Rebellion against social life	The psychiatrists consulted by their parents stated that they observed an intense crisis with symptoms of affective dissociation, developmental disharmonies and ambivalence of feelings. They added that he was going through a kind of autistic reverie that served as a shelter or alibi for a "characteristic rebellion" that prevented him from developing the "elementary conduct of social life." The "therapeutic plan": the first proposed action was, both, to the presentation of the musical "Hair" that was represented in those days in Buenos Aires. Later we talked for a long time in a coffee house.
Zoltan – 47 years old	Refused to undergo surgery to repair serious stomach injuries.	The patient refused to undergo surgery to repair serious stomach injuries. Clinic history: his father's death from stomach cancer and Zoltan is surgically intervened in an emergency on his stomach, in the front during the Second World War. We focused our action on the love he felt for his family and on imagining the pain and grief they would feel if he died, to finally observe that without proper medical care, with a good prognosis in the intervention, everything would be useless.
Andrew – 30 years old and father 65 years old	Young patient, a clinical doctor, asks for psychological assistance for his father in severe heart disease.	The dilemma between continuing his university career or collaborating in the father's construction company. He gets married and invites us to the wedding. There his father talks with us about his faults for the pressures he would exert on his son. Later the son asks us to go to the hospital to assist his father with a severe heart crisis. We were able to be present moments before being transferred to intensive care. He passed away moments later. Our attendance continued at the funeral ceremonies.
Alex – 40 years old	Economics professional in crisis because he is looking for a way to take revenge on the neonatologist who attended his first child, who suffered brain damage attributed to negligent professional treatment.	The child suffered repeated convulsions throughout the day and only his mother could approach or hold him. Any stranger, even a nurse, who tried to touch it caused the seizures. We elaborate on his fatherly situation in psychotherapy. Then we agreed to a visit to his house in which we made a practice of emotional approach to the child who accepted our arms for a moment without making convulsions. We transfer that practice to parents successfully.

 

             The first case in the table is Peter (fictitious name), 35-years-old man, who presented a frequent acute phobic state: the fear of going outside. He lived in a big city and worked in the most active commercial area. He complained that traffic congestion and people in the street at the time of entry to his work paralyzed him and did not dare to leave, with the consequent damage in the family environment. In the interview, to which he attends accompanied by his sister, he complained even of the red lights of the traffic lights that delayed his circulation by car. This had begun more than a year ago, almost imperceptible to his relatives but it was increasing and in the last month before the consultation, he had made crisis with the total refusal to go out. We observe that everything explodes when he feels alone with his anguish in the street. In the conversation of the first interview, other small phobias arise, diverse and almost incomprehensible to the common people. He was very reassured by the presence of his sister who acted, of course, as "phobic companion", an insurance function of the impossibility of suffering "damage" in his trips abroad. The sister waited an hour in the waiting room for the consultation to accompany him later to work or home.

           In his life story, night terrors appear in childhood, fear of dogs transmitted by his mother through excessive prevention of these animals, several moves in childhood and adolescence from smaller cities to the big city, few friendly relationships and none love relationship.

           After several sessions, we propose to the sister that next week bring him to consultation and then leave there. Of course, this is announced to the patient who rejects and distresses him. We ask the secretary to reserve two hours for this proposal. In the following week, perhaps heightened by curiosity, perhaps feeling a good feeling with the psychotherapist and a little motivated by his sister who insists on the convenience of trusting the proposed, attends promptly. His sister retires. Pedro shows (this is what we will call it) restlessness and distrust asking all the time about the next steps in therapy. We talked several minutes to achieve a suitable climate and reassure it as far as possible and we propose to go out together.

           This makes him very anxious; he refuses at first, asks if his sister will be outside or if he will come looking for him later, unmotivated laughter, walks nervously around the room and finally accepts. He insists on the phrase "don't leave me alone" all the time. We leave the consultation and take a taxi. He insists that we don't let him travel alone. The route is quite extensive along a great avenue of the city. During the trip we propose an exercise: to indicate when we pass through a shoe store (a very commercial avenue), then to point out several men's clothing stores, then women's clothing, later restaurants and finally that he remembers how many red traffic lights stopped us at the road (none because it is a fast traffic avenue coordinated at traffic lights). All this allows us to reach our destination without a single mention of your fears of traffic or the possibility of agglomerations once we arrive at your destination. When we arrive, we insist on Pedro to get off the taxi, cross the avenue and enter his office. He refuses a little but finally trusts and does. We return in the taxi to the home of origin.

           An additional anecdote before the analysis of the action: The taxi driver begins the return and asks “- Are you a psychologist? - Yes sir. - Look, I went through the same thing that surely happened this young man and for many years I had no help to overcome my fears. I wish I had met you then! My father forced me into a car and spent five hours strolling through all the streets of more intense traffic and congestion. When I came down, I cried for two days. Then the need made me become a taxi driver”.

            Peter's positive reaction as that of the taxi driver who both must attend work has a special relationship with the attitude of each of the "behaviour modifiers". The confidence achieved in the first sessions, the departure with the psychotherapist that the patient did not have planned and performed safely, the “exercises” of the journey and the final security in which he could cross the avenue and enter to work allowed the first step of a change that had to be achieved with subsequent consultations which, gradually, he attended without the presence of his sister. Sceptics will ask concerning the departure of a psychologist's consultation - Hasn't the Psychotherapist acted as a new counterphobic figure? Do not.

           The second case is that of Eduardo (fictitious name). A young teenager in crisis (18 years old) came to our office. The psychiatrists consulted by her parents stated that they observed a situation of intense crisis with symptoms of affective dissociation, developmental disharmony and ambivalence of feelings. They added that he was going through a kind of autistic dream that served as a shelter, refuge or alibi for a "character rebellion" that prevented him from developing the "elementary conduct of social life". They would not recommend psychotherapy because they affirmed that "transfer" was not possible with such symptom’s characteristic of a possible psychotic outbreak picture. This diagnosis transmitted to their parents, distressed by what they observed and explained, led them to carry out an additional consultation with a team of psychotherapists in which we participated. The team took advantage of this "possible" diagnosis and "recommended" inpatient treatment to do just the opposite. What mattered to us was “the person”, unique, unrepeatable, free but undergoing an intense adolescent identity crisis.

           We find "affective dissociation" in almost all adolescents. Pointing it out in a specific one (Eduardo) must be accompanied by an in-depth study of family history, the surrounding historical moment, the patient's intellectual capacity and professional opinion on a possible positive prognosis in the performance of individualized psychotherapy, created "to measure" for such a teenager.

           The team proposed that we take care of the main psychotherapeutic part, an active presence of the psychotherapist, reassuring, an intermediary between the exuberant fantasy that such a person produced (drawings, confinement, screaming, negative ideation) and reality. We proposed a "true presence", a "true reality" and a "therapist" who would heal with what he was. Of course, all psychotherapists also go through adolescence with conflicts. None of this was commented. He managed to bring a positive attitude to the encounter, a habitual attitude in our professional practice and life in general. Our Master Frankl always said that "I found meaning in my life by helping others find meaning in theirs." Thus, in this case, aid to the other as a person in the project prevailed, accompanying them in everything they could and appealing to all the values ​​that Dilthey already mentioned and Frankl made of them part of his logotherapeutic theory: values ​​of attitude, that would account of a new possible model. Values ​​of experience, which I have just mentioned in terms of personal history and what has been lived up to that moment. And finally, creative values: the possibility of leaving the strict framework of the so-called “science” and proposing an “appeal” from the therapist to the patient: “Be with me”.

           We started with the "therapeutic plan": the first action proposed was to attend, both, the presentation of the musical "Hair" that was performed in those days in Buenos Aires. A rock opera that portrayed the world of that time: the hippie movement, the anti-war claim for Vietnam, the rebellion and idealism in pursuit of a better world. And also, the sexual revolution.

            Hair marked a "before and after" in the history of musical comedy. Because it was one of the first titles that were not anchored in a plot, but a concept, in a purpose. The show was adapted to the needs of expression of feelings, ideas and community purposes that Eduardo held inside but that he only manifested with screams, obscene, grotesque or aggressive drawings that he drew on the walls of his room or on cardboard that he spun, one with another, like a “collage”. He was (we were) excited and happy during the show. Then, in a pub, the analysis of what was lived and the fundamental ideas projected in the musical. Eduardo was a very intelligent teenager, with abundant philosophical and political readings, so the conversation on these topics continued in several subsequent sessions, already held in the usual consultation. There were other outings: sharing lunch or coffee in a quiet place in the city. Always dialoguing about the meaning of existence, the lack of solidarity in the world with the disadvantaged or the hungry, freedom, its limitations and possibilities, the affective encounter with others or love.

            We had epistolary contact with Eduardo many years later. In a letter, he said: “That I write to you is not a mystery, I was always in “contact” with you. What characterized you and what I try to follow is, precisely, that courage not to hide behind a dogma or behind rigidities that, at this stage of the game, I know that more than seriousness they hide cowardice, comfort and ignorance. You have to be a little more careful than they (the rigid ones) because you assume what you do without having a dogmatic bumper. It is the risk of freedom that you and I talked about so much in those years. Going out with patients to a function or a meeting, drinking coffee, hugging them when their father dies, those things are just like that, being present, just that.”      

 

CONCLUSIONS

           Existential psychotherapy is defined from a philosophical and anthropological basis. It applies the phenomenological method and not based on predetermined techniques. We know from the literature that many existential psychotherapists avoid the techniques based on the fact that the use of any technique or the consideration of statistical elaborations can diminish the essential human qualities (freedom, responsibility, vital project, transcendence) and modify the special relationship of encounter that is promoted in the therapeutic relationship. We emphasize the importance of "presence." This "presence" of the therapist is to be in the "here and now", committed and free of expectations as much as possible. This is what we try to show in this work. This presence is not limited to a specific meeting in space and time. It is a committed presence during every one of the meetings, even those that occur outside the consultation. In that meeting, the therapist tries to put aside all the preconceptions regarding the process ("epojé" of the phenomenological method). With this attitude, the therapist seeks the objective of gaining a "contextual" understanding of the relationship and the patient's experiences. On many occasions, the therapist is aware that certain experiences of both members of the meeting can be significant and offer positive results for the achievement of the objectives of Psychotherapy. We wish to underline that this practice leads to an increase in well-being and the possibility of encountering meaning, except for cases of paranoid alterations, psychotic outbreaks and borderline situations.

           Seligman, M. (1995) and also Wampold and Imel, (2015) state that in general, all forms of psychotherapy are effective and on average most more or less equally useful if they can understand the specific characteristics of the clients to determine the best therapeutic approach for any assisted individual.

           Both in attending the cases mentioned in this work and in so many others in which we have intervened we have found that the positive assessment and empathy of the patient in this different way of psychotherapeutic consultation through the presence of the therapist outside of his practice was highly positive. We have had a special interest in pointing that the central emphasis of the existential psychotherapy proposed here is aimed at finding or realizing the meaning, a matter that is a decisive factor in the improvement of our patients.

 

REFERENCES:

•                Frankl, V. E. (1975) The Unconscious God. Pocket Books, New York.

•                Frankl, V. E. (1978) The Unheard Cry for Meaning. Psychotherapy & Humanism.  A Touchstone Book, New York.

•                Frankl, V. E. (1986) The Doctor and the Soul. From Psychotherapy to Logotherapy. Vintage Books, New York.

•                Frankl, V. E. (1988) The Will to Meaning. Foundations and Application of Logotherapy. New York: Meridian Book, New York.

•                Frankl, V. E. (1992) Man’s Search for Meaning. Beacon Press, Boston, Massachusetts.

•                Fromm, Erik (2005) To Have or to Be? The Nature of the Psyche. Published by Continuum International Publishing Group, London.

•                Guberman, M. y Pérez Soto, E. (2005) Diccionario de Logoterapia. Grupo Editorial Lumen, Buenos Aires.

•                Laín Entralgo, Pedro (1958) La curación por la palabra en la antigüedad clásica. Editorial Revista de Occidente. Madrid.

•                Längle, Alfried (2003) “The Art of Involving the Person” in: European Psychotherapy, vol 4, nº 1, p. 47-58, München: CIP Medien.

•                Martínez Robles, Y. A. (2017) Existential Therapy: Relational Theory and Practice for a Post-Cartesian World: Volume 1 – Edited by Círculo de Estudios de Psicoterapia Existencial, México.

•                Martínez-Romero Gandos, José (2011) La autotrascendencia de la obra del Dr. Viktor E. Frankl en nuestra práctica logoterapéutica. Published in “Logoterapia: encontrar sentido a la vida”. In: https://logoterapiagalicia.blogspot.com/2011/04/la-autotrascendencia-de-la-obra-del-dr.html  

•                Martínez-Romero Gandos, J. (2016) Psicoterapia Existencial: el mito de Perseo y la introducción de títeres en un caso de alucinaciones auditivas. Publicado en la Revista Peruana de Psicología y Trabajo Social. Vol. 5 Nº 1 – January/July, 2016

•                Martínez-Romero Gandos, J. (2017) UTILIZACIÓN DE MÁSCARAS EN EL PROCESO PSICOTERAPÉUTICO Teoría y práctica desde un enfoque humanístico-existencial. Publicado en Revista Latinoamericana de Psicoterapia Existencial UN ENFOQUE COMPRENSIVO DEL SER. Nº15.

•                Martínez-Romero Gandos, J. (2021) Logoterapia Grupal. Autotrascendencia recíproca. Fundamentación y práctica. Publicado en Amazón Books, en versión papel y e-book. Mayo de 2021.

•                Plato (1919) Charmenides. In Dialogs (ed. C.I. Hermann. Vol. 9, pg. 5). Second Edition published by Routledge, New York, USA:

•                Seligman, Martín (1995) The effectiveness of psychotherapy. The Consumer Reports study. Published in The American psychologist. University of Pennsylvania, USA.

•                Wampold, B. and Imel, Z. (2015) The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work (Counseling and Psychotherapy: Investigating Practice. Second Edition published by Routledge, New Yor, USA.

•                World Confederation of Existential Psychotherapies (2016) What is existential therapy?  W.C.E.P. definition. In Revista Latinoamericana de Psicoterapia Existencial. Un enfoque comprensivo del ser.  Nº13. Spanish traslation by Dr José Martínez-Romero Gandos.

•                Yalom, I (2002) The Gift of Therapy. An open letter to a new generation of therapists and their patients. Perennial Library, Harper Collins Publishers, U.S.A.

•                Yalom, I. (1980) Existential Psychoterapy, Yalom Family Trust, Basic Books. Harper Collins Publishers, U.S.A.

PSICOTERAPIA FUERA DE LA CONSULTA. Encuentro e interacción desde al Análisis Existencial y la Logoterapia

 

En este libro el autor invita al lector a dialogar sobre la posibilidad de realizar una Psicoterapia alejada del habitual tratamiento en un consultorio o institución. Basa su presentación en los fundamentos del Análisis Existencial y la Logoterapia del Dr. V. Frankl. El propósito principal vincula el texto con la asistencia psicoterapéutica fuera del lugar de consulta habitual, tarea no fácil pero asombrosamente rica en experiencias tanto para el paciente como para el psicoterapeuta. El autor pregunta: “¿todo tiene que suceder en un espacio determinado? Esta afirmación podrá ser polémica pero podemos decir que “no siempre”.

Marcelo Rodríguez Cebeiro (2020) nos dice que: “Para lograr tener la flexibilidad de externarse con el paciente en la consulta, es necesario entender que el encuadre, no solo se encuentra en el contexto donde desarrolla la psicoterapia, más aún, ese contexto es la construcción del terapeuta desde su modelo y estilo. Ni la distancia de los sillones, ni el escritorio, o la bata que se viste en hospitales, ponen al resguardo la relación”.

El libro cuenta con numerosos casos en los que se describe esta actitud profesional de asistir al otro, de acuerdo a su circunstancia, aunque ésta suceda fuera del local de consulta habitual.

Etimológicamente el término “consulta” deriva del latín “consulere” (Unus peritus, si casus ferat, consuli possunt. Un experto, si es necesario, se puede consultar.) Como relación con la profesión que ejercemos en procura de la “salud” ésta en latín se expresa como “valetudini consulens”, consulta sobre salud.

Cuando una persona acude a un psicólogo o psicóloga con una inquietud, también se habla de consulta. La consulta es el tiempo en que el paciente está junto al profesional en un espacio determinado (el consultorio), mientras el profesional brinda su parecer y recomienda los pasos a seguir. Legalmente todo lo acontecido en la “consulta” debe ser registrado en una “historia clínica”.

Pero ¿todo tiene que suceder en un espacio determinado? Esta afirmación podrá ser polémica pero podemos decir que “no siempre”.

Para ilustrar lo que entendemos en este trabajo con el concepto de “Psicoterapia fuera de la consulta” volvemos al texto de Marcelo Rodríguez Cebeiro (2020) cuando dice: “Para lograr tener la flexibilidad de externarse con el paciente en la consulta, es necesario entender que el encuadre, no solo se encuentra en el contexto donde desarrolla la psicoterapia, más aún, ese contexto es la construcción del terapeuta desde su modelo y estilo. Ni la distancia de los sillones, ni el escritorio, o el guardapolvo que se viste en hospitales, ponen al resguardo la relación”.

Son objetos que se colocan para demarcar una diferencia y a veces operan como una defensa omnipotente del profesional. Los profesionales más nóveles e inseguros, necesitan de esa parafernalia para sentirse fuertes en el rol. Por lo tanto, el encuadre, cuanto más rígido es mayor es la defensa del terapeuta.

El encuadre se encuentra dentro de la mente del profesional. Esta concepción parte de la autovaloración y la consecuente seguridad. El terapeuta es el gran conductor y es el que impone las reglas de juego en esa amalgama interactiva con el paciente en busca de una complementariedad que facilite cumplir con los objetivos de manera eficaz y rápida. Se encuentre donde se encuentre el profesional, si tiene en claro su rol y función, no necesitará de nada para ejercerla, solo sus conocimientos y pasión.”

El Dr. José Martínez-Romero Gandos desarrolló su carrera profesional en Argentina y Latinoamérica por más de 35 años. Actualmente reside y trabaja en Galicia – España. Licenciado y Doctor en Psicología atesora un trabajo de más de 20 años en hospitales y 50 en actividad privada. Esto le permitió tener un aprendizaje y un conocimiento profundo de la relación psicólogo-paciente y con la familia. Docente Universitario, Conferencista e integrante de Mesas de su especialidad en Congresos fue fundador (hace 30 años) de la Fundación Argentina de Logoterapia “Viktor E. Frankl”, de Buenos Aires, Argentina.

El libro ha sido editado en el mes de agosto de 2022 a través de Amazón en versión papel y en e-book, con un precio accesible para todo público.

LA VIDA, LA MUERTE, EL DUELO COMPARADOS ETOLÓGICAMENTE POR EL DR. JOEL VOS

 

 El Dr. Joel Vos es un Psicólogo, Filósofo, Investigador y Terapeuta Existencial, con numerosas publicaciones en el ámbito de su profesión. Investigador sénior, profesor titula, supervisor de investigaciones en Metanoia Counseling & Psychotherapy Service (MCPS) y en New School of Psychotherapy & Counselling, London (UK). Master en Psicología Clinica (cum laude) por la Nederland University. Psicólogo (cum laude) por la Leiden University (Nederland).

 Dice el Dr. Vos en su publicación:

No sabía que las vacas pudieran lamentarse por la muerte de otra especie. Esta vaca estaba claramente afligida por una oveja muerta. Intentó que la ayudara mugiendo y caminando hacia mí, pero no pude ayudarla porque la oveja había muerto hacía unos días. Siguió caminando hacia la oveja muerta, inclinando la cabeza y oliendo. Pero no tocaba a la oveja ni hacía nada para que se levantara, como haría la vaca si supiera que la oveja estaba viva; he visto, por ejemplo, vacas que empujan a otras vacas si necesitan ser despertadas o alertadas. Luego volvió a caminar hacia mí, hacia la oveja, y así sucesivamente. Me impresiona ver el duelo de esta vaca. Puede que sea mi antropomorfismo, pero creo que puedo ver la pena en sus ojos. Se me llenaron los ojos de lágrimas al ver su dolor. Le dije que no podía ayudar porque la oveja estaba muerta; por supuesto, la vaca no entiende mis palabras, pero puede captar mi tono de voz. El resto del rebaño de vacas me rodeó y una madre empezó a alimentar a su cría a un metro delante de mí, algo que nunca hacen cuando hay humanos extraños cerca; era como si estuviéramos juntos en el duelo. Había entrado accidentalmente en un servicio fúnebre.

Creo que todos los animales, incluidos los humanos, tienen un impulso hacia la vida. Queremos vivir. También entendemos que otros quieren vivir, y por eso nos lamentamos cuando vemos a otro ser muerto. Lo más probable es que esta vaca no tuviera la capacidad neurológica para reflexionar sobre su propia mortalidad, pero sí para reconocer la muerte y que ésta es mala. Al parecer, el significado malo de la muerte está profundamente arraigado en todos los seres vivos, viene de una etapa temprana de la evolución. No creo que esta vaca conociera personalmente a esta oveja, ya que las diferentes especies no suelen interactuar mucho, aunque no puedo descartar la posibilidad de que esta oveja fuera su compañera. En resumen, creo que esta vaca entendía el concepto de la muerte a un nivel muy básico, y estaba afligida.

Las investigaciones etológicas, por ejemplo, las del Dr. Frans de Waal, han demostrado cómo las especies superiores, como los chimpancés, ayudan a otras especies si hay un enemigo colectivo. Por ejemplo, cuando hay un incendio forestal, una madre mono puede ayudar a salvar a las crías de otras especies. La empatía y el apoyo son comunes en todas las especies, especialmente si hay una amenaza de muerte: la mayoría de los animales quieren preservar la vida (la mayoría de las especies animales no matan por diversión, excepto el gato doméstico). Como mi historia de "haber sido rescatado" por una vaca cuando me quedé atascado en el barro el año pasado en España. Pero normalmente la pena por otras especies se ha observado en especies superiores, no por ejemplo en las vacas, por lo que conozco la investigación.

Los seres humanos tienen un neocórtex que la vaca no tenía. Este neocórtex puede hacernos reflexionar sobre la muerte, incluida nuestra propia mortalidad. También podemos negar la muerte, como ha demostrado la Teoría de la Gestión del Terror. Por otro lado, también podemos tratar de encontrar un significado en respuesta a la muerte. Resulta sorprendente que los tipos de significado que facilitan la vida de la especie sean también los mejores para nuestro bienestar mental y físico: nos beneficiamos más de centrarnos en tipos de significado sociales y más amplios (por ejemplo, conexiones sociales, ayuda a los demás, un propósito más amplio, ética) que en tipos de significado materialistas, hedonistas u orientados al yo. Parece que los tipos de significado que se sienten más satisfactorios son también los mejores para fomentar la vida de nuestra especie. Por lo tanto, se puede plantear la hipótesis de que es nuestro impulso evolutivo hacia la vida lo que subyace a nuestros tipos de significado más satisfactorios en la vida, y lo que nos hace temer la muerte. Podemos parecer muy avanzados como seres humanos, pero en su más pura esencia podemos tener los mismos sentimientos que esta vaca. Amamos la vida y odiamos la muerte; todo lo demás es una complicación innecesaria de nuestro neocórtex...".

También he observado que cuando los animales están angustiados, empiezan a alimentarse. Por ejemplo, cuando los corderos jóvenes ven a un excursionista, corren hacia su madre para alimentarse. Alimentarse es una respuesta al estrés, como demuestran las investigaciones: los animales y los humanos responden al estrés luchando, huyendo, congelándose o alimentándose. Una cría y su madre parecían responder de la misma manera a mi presencia y a su estrés por la oveja muerta. Al igual que la gente empieza a comer o beber después de un funeral.

Esto arroja una luz importante sobre los procesos de duelo humanos: aparentemente el dolor está profundamente arraigado en nuestro viejo cerebro.

Los animales son muy inteligentes. ¿Por qué íbamos a matarlos, si tienen sentimientos como nosotros?

Traducción del original, publicado en Fb el 10-08-2022, por el Dr. José Martínez-Romero
Gandos con autorización del autor.