Pavel Volkov (Russia) Experience of Clinical Existential Approach (Psychotherapeutic Essay) Part 3, continued from Issue 6

The link between client-centredness and integration. In its full form, client-centredness is manifested as follows:

1. The client’s role in psychotherapeutic process is active, and optimal conditions after Carl Rogers’s model are to be created for that. The model employed is co-operation.
2. Client’s inherent value. The client is entitled to have his or her own values, choices and worldviews.
3. Method and ideologies of therapeutic help are selected creatively and sometimes even invented to suit the particular client rather than existing before the client.
4. Nothing should be imagined or implied, work must be undertaken exactly on the client’s ‘material’.
5. Minimum of indoctrination. The knowledge and methods of a psychotherapist should be aimed at awakening the client’s own language and will to be cured.
6. In deep psychotherapeutic work, the therapist has to reconsider his or her prior knowledge and tailor them to the client’s needs rather than vice versa.
7. Psychotherapeutic help must be such as to assist the given client without breaking the principles of the client’s inner universe. This position may reverse the entire situation. It may happen that the client needs directive, even forceful and provoking assistance. In this case, client-centred aid might appear as not being aimed at the client.

The way through the labyrinthine passages of the client-centred quest can be found by being intimately tuned to receive the client’s verbal and non-verbal signals.

Existential and individual foundations for an integrated approach. Research into one’s approach makes the therapist look into his or her own character as the source of his or her approach.

Integration can be justified from the purely pragmatic perspective: the larger the range of help, the more efficient it is. One of the founders of multimodal (integrational) approach, Arnold Lasarus, worked exactly by this principle. As far as I know, however, Lazarus did not look into the issue of the therapist’s world perception in detail, while this issue forms the premises of integrational approach. I see the question of personality and methodology in psychotherapy as being of primary importance.

The experience of Nothingness helped me to find a way of moving through the world while avoiding theoretical constructions. I realized the possibility of being spiritual without being confined to a particular religion or system. The landmarks of my spiritual development are provided through intuitive dualisms of the living and the dead, of the warm and the cold, of the sophisticated and the crude, of the vulnerable and the senseless, of the kind and the aggressive, of personal development and self-content. These criteria are applicable to different worldviews.

It seems to me that mutual understanding between people relies not on theoretical constructs, which divide rather than unite but on primary, pre-philosophic foundations. The learned men turn life into knowledge, but how can we convert information into the colour of the sunset or the bitterness of wormwood? Do not people for the most part take the existence of the world for granted? One can build theories only about the nature of the world’s existence: do we dream of it, is it given by someone, is it a fallen one? But how can we explain the warmth of human soul? Can we measure it with a thermometer?

Antinomic thinking. Antinomy is neither contradiction nor schisis, though it may resemble both. It is a peculiarity of thinking.

Why should I, a psychotherapist, need antinomic thinking? By being at the position of antinomic thinking in relation to other people, I position myself in a more tolerant and open position towards them.

Antinomic thinking is characterised by the absence of univocal answers to many questions, even to the most important ones. A man is made to always ask the questions to which he can find no answer. The tension between eternal questions and imperfect answers provides impetus for the development of culture.

Certain premises, methods and tools of clinical-existential approach. A psychotherapist should think about his or her psychotherapeutic experience from the inside, it should be the wisdom of experience and not the wisdom of intellectual exercise (Vasilyuk, 1992, 2008).

1. Co-operation, individualization and creative search
2. Specifics of contact with the client
3. Inductive approach, feedback and intuitiveness
4. Two types of resistance
5. Peculiarities of character and personality
6. Character diagnosis and diagnostics. Character study and typology
7. The principle of tuning in.

I believe that clinical and psychological knowledge can compliment each other to a much larger extent than is commonly admitted.

In my practice, I saw that certain psychotherapeutic approaches can be alien to certain people, but it is always possible to extract certain useful elements out of them. This principle is vital for clinical-existential approach. I cannot even imagine how I would be able to help people if I did not have three different educations: in psychiatry, psychotherapy and psychology. I am both psychiatrist and psychologist, and, what is more, I am a psychotherapist.
(To be continued)