Original book published in Spanish by Amazon Books. Paper version and e-book
Dr José Martínez-Romero Gandos
August 2022.
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
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. |
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.
No hay comentarios:
Publicar un comentario