Active collaboration in the treatment, even when corroborated by drugs, is decisive for achieving the desired objectives. A vision that has established itself since the 90s
Maybe it’s nice to know that we are always our own therapists, or at least that we can never miss our direct personal contribution, whatever psychotherapy we decide to follow.
Only half the way
In fact, far from being a passive process, a trust without having to make any effort, psychotherapy emerges as a necessarily active process as explained in the book Exiting mental suffering – Stories of treatment and self-therapy (tab editions, 2022) by Giovanni Fava, professor of psychiatry at the University of Buffalo, New York. When I prescribe a drug to a patient, I always add a second prescription to the recipe with the pharmacological indications, which also contains indications for self-therapy, underlines Fava. I explain that the first prescription can contribute, at best, 50 percent of the outcome. The second must stimulate the other 50 percent, which concerns what the person can do to help his own improvement process. These are often very simple indications, which concern lifestyle, and serve to ensure that the patient takes an active role in his own therapy and does not stay at home waiting for the drug to take effect. I try to make it clear the medicine a crutch, which can help to take actions and deal with situations that that person may not be able to do at the moment. Without this kind of effort, the drug risks being useless, a kind of crutch that is kept in a corner.
Theoretical bases
The vision of psychotherapy as an active phenomenon on the part of the patient has solid theoretical foundations, even if in the current view this form of treatment is often misinterpreted as a sort of recourse to a therapist who will have to find the way out of the condition of malaise, also indicating the path to follow. But, already in the early nineties, Jerome David Frank, professor of psychiatry at Johns Hopkins University, had clarified how psychotherapy is basically a guided self-therapy, which is based on the psychotherapist’s ability to set in motion the internal healing forces that each of us has. In Frank’s vision, the therapist’s task, through the special relationship that is established, is to indicate the way, to help overcome the difficulties that may be encountered, and also to instill the strength and confidence that are necessary to follow it specific Fava.
Stages to go through
In order for this process to take place, it is necessary for the patient to go through certain phases, even if this does not mean that psychotherapy must necessarily take a long time. Indeed, the current practice of psychotherapies, increasingly of cognitive-behavioral derivation, is based on a relatively small number of sessions. For example, in cognitive behavioral therapy the patient is initially invited to try to recognize and identify the moments and emotions of greatest discomfort in a diary. an important phase because from that first platform we can then proceed towards attempts at change. In Well-Being Therapy, developed by Fava himself in Italy and now practiced all over the world, the procedure is similar, but the objective of the diary is aimed at moments of psychological well-being. In the initial stage, with the help of the therapist, the person discovers what makes her feel good and what tends to interrupt these moments. The realization of an indispensable phase in order to be able to move on to the subsequent ones, based on self-therapy, in a balance between the patient’s commitment and that of the therapist who, however, tends to assume more of a guiding role on what to do, leaving to patient the task of realizing his own steps. An unwritten rule in psychotherapy, but which I learned the hard way with people who unexpectedly interrupted it, that it is counterproductive to move on to a subsequent phase if a complete mastery of the previous one has not been acquired first, it reinforces Fava. It is not a question of wasting time, but of facing difficulties, resistances, and in some cases of identifying counter-therapeutic factors which work against the progress of the therapy.
Phobias
An example of psychotherapy from which the active role that the patient must assume emerges in a particularly evident way is that implemented with phobias, such as agoraphobia – the fear of feeling sick and not being able to be helped – and social phobia. These are psychotherapeutic techniques based on progressive exposure to the object of fears, which the patient carries out on his own between one session and another in a gradual and programmed manner. Says Fava, who directed Psychotherapy and Psychosomatics, one of the most important international scientific journals of psychiatry and psychology: The level of participation of the patient can be very different, since he can only carry out some of the tasks that are assigned to him, or he can decide to modify them and even to add others in addition to those that have been prescribed. The main technical difficulty lies precisely in being able to program the exposure in relation to the response times of that specific person, also in relation to the level of difficulty or actual disability determined by phobic avoidance. a continuous balance between encouragement to be “administered” when it really is needed, and an invitation to caution when one realizes that the time is not right. Each brief psychotherapy is therefore a unique, individual journey, where the most important variable is the level of self-therapy that the patient manages to reach and which continues even after the end of psychotherapy.
December 4, 2022 (change December 4, 2022 | 17:22)
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