Back to the basics but not self-evident (2): further aspects of psychotherapy

*** This article is based on sources from my book “Dance of the miracles: the big journeys in the small steps” (in Greek – for now).
*** The image of the article is by Ermia Ersi.

 

[A]  Introduction

I uploaded this series of 4 short articles with my personal view on a few conceptual “basics” of psychotherapy, because I think that generally (at least in my country) there are several misconceptions around this word.

In the 1st article, I attempted to present a very brief introduction about the nature of psychotherapy and the identity of the psychotherapist.

In this article, the 2nd one of the series, I wish to go a little deeper in this concept, touching also the very subtle issue of the several existing psychotherapeutic modalities in our days.  

 

[1] What the “psychotherapist” does – the psychotherapeutic relationship.

Today, we know that the possible beneficial effects of the psychotherapeutic process are not based so much on the contents of the verbal, conscious psychotherapist-client communication.
They are mainly due to what happens between them and to how they connect directly between them – in other words, to the psychotherapeutic relationship .

In this relationship, the trained psychotherapist takes care of the various needs of the client and the ways in which he/she understands and takes care of them.
These needs may have to do with the body, the mind or the feelings of the client.
However, of course, no matter on which level such needs are principally expressed, they affect the wholeness of the client.

Psychotherapy, as a primary or complementary tool, helps the client to explore these needs in his/her subjective reality as well as the ways he/she understands them and responds to them through his/her praxis (action) in the situations of her/his life.

Nevertheless, the psychotherapist does not provide ready, magical solutions.
Rather, he/she becomes a kind of catalyst so that the client may enrich her/his awareness about his/her needs and responses to them.
In a sense, a psychotherapist and a client are traveling in a path that they build together, directly, live, from session to  session.

 

[2] Psychotherapy, philosophical assumptions, psychotherapeutic approaches.

Every kind of structured psychotherapeutic approach has “a cognitive system defining how things are related and how things happen” (Crocker, as cited by Brownell, 2010, p. 8).
Such an organised set of ideas (“principles”) combined with each other, form a kind of “philosophy” (or rather philosophical assumptions) about our nature, life, physical and inner reality, the purposes, well-being and the interactions of human existence.

The fact that every form of psychotherapeutic act relies on such philosophical assumptions means that there are de facto many ways of psychotherapeutic practice, depending on the nature of the philosophical assumptions at their foundation.
Or, according to Susan Gregory (2015, personal communication), we would say that there are many psychotherapeutic “modalities”.

Such psychotherapeutic “modalities” are often referred to as “approaches”, defined by their chosen principles (psychoanalytic, cognitive – behavioural, psychodynamic, Gestalt therapy, person-centered, systemic, existential approach, etc.).
That is, in the A approach the chosen coral principles about the world, life and the human being, are different from the coral principles in the approaches B, C, D, etc.

In other words, the term “psychotherapy”, today, could be seen as a very wide umbrella framing the various psychotherapeutic approaches. Somewhat that happens with the word “car”: it is a general conceptual framework for the different kinds of cars – Opel, Fiat, Skoda, Renault etc.

 

[3] Saying differently similar things.

Many of the theoretical principles of the various psychotherapeutic modalities are common and overlapping. However, in the context of the whole philosophical foundation of each modality, common principles acquire different nuances and lead to different methodologies.
Let’s say, Gestalt therapy modality and the person-centered one, believe fundamentally in the therapeutic relationship. Nevertheless, methodologically, the therapeutic relationship is used differently.

Also today, I think that the following unfortunate phenomenon is observed: as I just said, many psychotherapeutic modalities are based on very similar principles, they are following almost the same practice, but use different terminology to describe their common aspects.

For example, through what point of view we may name the fact that today all modalities place the client in the wider field in which he/she lives and explore how she/he interacts in this field?
Shall we say that this fact is holism, field theory, systems theory and name the same thing using different terms from each one of these fields?
No matter how the importance of the client’s life-field is named, the essence remains: we generally mean the same thing, but we baptise it differently.

The result; Confusion and chaos, both for trainees and for clients, because (always in my opinion) the psychotherapeutic modalities very rarely make the step to put together on the table their principles and mutually create a somewhat common language of communication.

 

[4] The psychotherapeutic “praxis”.

A psychotherapeutic modality, precisely because it is characterised by a philosophical orientation on its theoretical basis, has clear objectives in terms of how it perceives:
(a) the functional interaction of the individual with the world and
(b) the very general sense of the “better” the client asks for.

Also, since a modality has some goals, it also has a system of organised and structured thinking which produce the ways (the praxis) in which these goals will be achieved.
Thus, the “psychotherapeutic praxis” of a certain modality is shaped on the basis of its objectives, structures and methodology.
Moreover, this praxis can be seen as “animating the theoretical bases of the psychotherapeutic process through what the psychotherapist and the client do directly in it” (Brownell, 2010, p.8).

 

[5] Framing “psychotherapy.

Psychotherapy is not just a friendly conversation, nor an unnecessary waste of time, it is not a game to spend on your time, and it is not a “medical” type of intervention (“medical” in the sense of the linear relationship of cause and effect to the process of intervention – Brownell, 2010).
Also, because psychotherapy deals with the subjective experience of the individual and the group, it does not aim to “correct” anyone according to specific standards, nor does it emphasise the provision of community services.

Of course, psychotherapy can clearly be provided in the functional context of a social institution. But this concerns issues that have to do with duration, place, choice of psychotherapist and not what happens in the psychotherapeutic process itself.

 

[6] Psychotherapy has to do with real life praxis.

Psychotherapy sees human existence on physical, emotional and mental levels.
What I learn experientially while being in psychotherapy about myself and about my actions must become a consciously assimilated tool for my future experiences and my course in life.
I can not talk about psychotherapy if eventually, for whatever reason, the psychotherapeutic experience does not lead holistically to some practical attitude in things, so that I can consciously and responsibly use the results of this experience in the future.

 

[7] All that works “therapeutically” is NOT necessarily psychotherapy.

After all this, I find it important to underline that although psychotherapy can work therapeutically, healing or curing, it should never be entirely identified with any of these three words (please, see my 1st article of the series).
The word “therapy”, when used in everyday language rather than as an abbreviation of the word “psychotherapy”, has nothing to do with what the word “psychotherapy” means.
The same is for the words “cure” and “heal”: they do not cover the prerequisites (principles, structure and methodology) that are necessary to allow these words to connect in any way with “psychotherapy”.

Moreover, anything that simply works “therapeutically” in a broad sense is not psychotherapy.
A good massage, artistic experience, holidays, good sex, swimming, yoga, reflexology, gymnastics can be “therapeutic” but in no way they are psychotherapy.

However, in order to avoid misunderstandings, I stress that the clarification of the boundaries of the word “therapeutic” does not negate the great and often decisive significance of any simple therapeutic rather than psychotherapeutic process.

I insist so much in such delicate conceptual nuances, only because I think that in our days and for various dishonest reasons, there are many people abuse the term “psychotherapy” – for money or control or megalomania, they fool the naïve and exploit human pain.

 

[8] What is healthy is subjective.

In today’s psychotherapy, relativism prevails, at least in humanistic approaches that are oriented towards the respect for individual reality and the relationship of everything to everything.
What is “healthy” and what is “illness” or catastrophic dysfunction is not a model issue.
It is more about the subjective reality of the client within his/her personal life.

 

[9] The psychotherapist is not an “objective” observer.

At the same time, the psychotherapist himself is no longer considered the authority, which will judge what is “good” for the person with whom she/he works, knowing “objectively” what is “good” and what is not for the client.
That is, the psychotherapist does not consider him/herself an “objective” observer, but rather a subject as it happens with the client.
And this means that the psychotherapeutic relationship is co-created through the live interaction of a psychotherapist-client.

 

[10] Epilogue.

Finally, for all these reasons and for many others, perhaps we should reconsider more decisively that the very word “psychotherapy” is by now probably inappropriate or inadequate to describe the processes between the persons called “psychotherapist” and “client”.

However, until a wider collective need brings about such a radical reconsideration, I think that it is  absolutely necessary, in our day of arbitrariness, of brutal violence and profiteering, to protect what precious processes are included in the meaning of the still valid word “psychotherapy”.

Psychotherapy is of course not panacea for all troubles.
Nevertheless, psychotherapy is for sure a highly valuable contribution to the support of the distorted image which our days reflect for the human existence, as long as there is care for meaningful and substantial consideration of the  psychotherapeutic theory and praxis.


References

***Brownell, F. (2010). Gestalt Therapy, A guide to contemporary practice. New York, NY: Springer Publishing Company.

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