A mental health horror story — is there truth to this fiction?

This is a story about the consequence of not understanding the client in the mental health profession. 

It is necessary to emphasize the importance of understanding and the dangers of misunderstanding caused by pre-conceived ideas. Stammler (2009) cited a story written by Gabriel Garcia Márquez (1994), which I find interesting to relate: 

A young woman, whose care breaks down on a country road in the pouring rain and who tries to get a lift to the next telephone. After a long time, the driver of a van picks her up. In the van are a group of sleeping passengers covered with blankets. As she is cold and wet the woman gets a blanket too. 

After a while the van stops. Together with the other passengers she gets out and enters a building. She meets a woman in uniform and tells her she wants to make a phone call. She is ordered to join the other women in the communal dormitory. Sudden­ly awake to the fact that she is in a psychiatric hospital, she tries to escape—to no avail. Her explanations, protests, and attempts to leave the building were unsuccessful; they were answered with force and sedation. The next day she is introduced to the medical director of the hospital. He deals with her in a very friendly and patient manner. She tries to convince him that she has only come to make a phone call and repeatedly de­mands to be permitted to call her husband and inform him of her whereabouts. The doc-tor speaks to her in a fatherly voice saying “Everything in due course”—and finishes the conversation. 

A few weeks later she manages to send a message to her husband. The price is high; she has to give in to the sexual advances of the night nurse. The visit of her hus­band to the hospital from which she expects her liberation begins between him and the medical director. The latter explains to the former the mental disease of the wife. He talks of the states of excitation, vehement outbursts of aggression and fixed ideas (espe­cially the one to make phone calls); further treatments as well as the sympathetic coop­eration of the husband for the sake of a positive course of the disease are strictly indi­cated

After having been informed in this way, the husband sees the wife. He soothes her, encourages her, tells her that she will soon feel better, and promises to come to visit with her on a regular basis. At first she is perplexed; then she starts to rave and to scream like a maniac. On her husbands next visit, she refuses to see him. The doctor says to him calmly, “that is a typical reaction, it will pass” (p. 68). 

This almost true-to-life horror story tells us what can happen to clients who slip into dependency on professionals for solutions, and end up being labelled by their diagnoses and misunderstood. It highlights the problem of non-active listening on the part of the professional who engage themselves in analyzing without consideration for what is real­ly happening with the client. Therapists who are fixated on their pre-conceived theories tend to adopt a one-theory-fits-all, which deprives the client of exploring his/her own meanings. This mirrors what Reich was trying to explain with the case studies discussed above: where the therapist was too busy at doing the job of analysis to see-and-hear the client. In the story above the staff at the psychiatric hospital were so busy at being “pro­fessional” that they lost sight of seeing the client, not realizing that the client was not really meant to have been there. This is compounded by the influence professionals have on the public who hold the professional in often too high regard. This kind of mis­use of professional status breaks the ethical code of doing no harm: “In providing ser­vices… (psychotherapists) bear a heavy social responsibility because their recommen­dations and professional actions may alter the lives of others” (European Association for Psychotherapy, 2002, p. §1.1.a). 

Why do such oversights also happen in psychotherapy? Is this what we do on a daily basis in psychiatry? Diagnosing children with ADHD, depression and prescribing psycho pharmaceuticals without first attempting at understanding the pathological field in which the patient resides?

Reich writes of this kind of failure to recognize what is really going on with the client (e.g. transferences), and being too much in need of being complimented (from others and also by the self) : “Un­doubtedly, this can be traced back to our narcissism…” (Reich, 1945/1984, p. 25). Which leads us back to the reality that psychotherapy is about understanding the client and the process of which requires the therapist to first understand themself.

Reference

European Association for Psychotherapy. (2002). Statement of Ethical Principles. Retrieved 2016, from European Association for Psychotherapy: http://www.europsyche.org/contents/13134/statement-of-ethical-principles

Márquez, G. G. (1994). Strange Pilgrims. London: Penguin.

Owen, I. R. (2015). Phenomenology in Action in Psychotherapy.

Reich, W. (1945/1984). Character Analysis (3rd ed.). (M. H. Raphael, Ed., & V. R. Carfagno, Trans.) NY: Farrar, Straus and Girouy. 

Staemmler, F.-M. (2009). The willingness to be uncertain: Preliminary thoughts about intepretation and understanding in Gestalt Therapy. In L. J. Hycner (Ed.), Relational approaches in Gestalt Therapy (pp. 65-110). NY: Gestalt Press.

The Importance of therapist’s Self-awareness & Phenomenological Attitude 

Owen (2015), in Phenomenology in Action in Psychotherapy, explains “Understandings at explicit and implicit levels form worlds with others where there are common objects of attention.” In the therapeutic relationship (as with any relationship), contact is made when there is awareness that what each individual understands of the situation is subjec­tive.

This understanding functions to bring common ground in the relationship. Owen adds that “People have unique personalities and inhabit social contexts and culture, in larger contexts of society and history, through being aware of meaningful cultural ob­jects (although such conscious awareness is influenced by implicit and biological forc­es). Therefore, a special attention is provided for what it means to relate in a context, (…) This includes the consideration of meaning within an attention to the therapeutic relationship in psychotherapy” (p. 2). The therapist, for the maintenance of the alliance, needs to first be conscious of these socio-cultural biases of the therapist’s self towards the phenomena of the on-going present situation in the therapy session.

As discussed in this article, awareness of transference and countertransference forces within the alliance is the tool for the therapist to work through the patient’s resistance, and providing effec­tive psychotherapy. Absence of this awareness on the part of the therapist, renders the therapy process at best non-effective.

Reference

Owen, I. R. (2015). Phenomenology in Action in Psychotherapy.