Pavel Volkov (Russia). Experience of clinical existential approach (psychotherapeutic essay)

Part 4, beginning in issue 6 (2013) of the journal

Two types of resistance. The first type of resistance was discovered by Freud, so I shall call it psychoanalytical. It is the kind of resistance that surges in the patient at facing pain, fear, inability to counter changes. There is nothing but to overcome or subtly avoid this resistance, helping patient face the very thing he or she prefers to avoid. The second type of resistance is completely different, and, unfortunately, little is said about it. Essentially, it happens when the patient is resisting in response to a wrong way of treating him. A psychotherapist’s reaction is not to overcome this resistance but to change the tactics.

This way, the fact of a patient’s resistance points to two completely different directions. It is completely possible to discriminate between them in practice. In the first case, the resistance is directed at something within oneself, while, in the second case, the resistance is directed at the imprecise actions of a therapist. A psychotherapist who cannot distinguish these two types of resistance finds the client-oriented way to be obstructed.

Differences of character and personality. The following notions exist: type of person, character, a person’s nature, individuality and personality. The type of individual is an oxymoron, because a type has no individuality. An individual is someone unique, distinct from the traits common to many, as compared to a type. In fact, when speaking about a type of a person, we mean his or her character.

A person’s nature is a very broad notion, which enables everybody to have their say on it: a psychoanalyst, an existential psychotherapist, a clinical therapist, etc. There are people who think that a person has no character, but, as a rule, even they can think about a person’s nature.

Individuality refers to the peculiarity of character particular for the given person. This notion refers to uniqueness without stressing value.

Nevertheless, these issues require caution. It is likely that, while a person lives, he or she has the presumption of undiscovered authenticity. A personality is a unique inner world of a person, created by him or her because of his or her efforts. The inner world needs not have an author and may represent a conglomeration of introjects. Introjects are taken by a person from the culture or tradition without critically processing it. A personality also means a degree of autonomy and freedom from external influence, and, naturally, self-construction of one’s attitude to the surrounding world.

The science of personology studies the unique and peculiar traits of a person. A clinical and existential approach is a mutually complementing union of characterology and personology. When we address a person in psychotherapy, we work in union with this person on the person’s character.

Characterological diagnosis and diagnostics. Characterology and typology. A diagnosis (from the Greek ‘to discern’) is not a scheme or some words; it is a living process of getting to know, discerning a person. Often, I can foretell what you will say and how you will behave. And, if you ask me, I can tell you something about the rules that govern your feelings. And, of course, I do not know everything about you.

Would a loving person or talented writers, such as A. P. Chekhov or Somerset Maugham see a person otherwise? Then how is psychotherapist characterologist different in his or her knowledge from a writer? A writer’s task is to provoke feelings in the reader, and the writer is not concerned with precise discerning of new rules. The task of science is to convert life into convincing, verifiable and reproducible knowledge. A psychotherapist characterologist uses laws and rules to help patients. These rules are professional knowledge, it needs to be purposefully studied and it requires special terminology for its expression. What is a term?

A term is a scientific word, and it includes the work of several generations of scholars, the essence of their experience of observation and meditation. To learn a term does not mean only to understand this notion but also to learn to perceive (to see, to hear and to feel) the reality it signifies. A term is an accretion to reality. It enables to see more clearly something that can be overlooked without it.

Thus, professional diagnostics means structuring one’s view of a person using contemporary scientific notions. I believe that diagnostics is the art of concordance and compliance. Sometimes, several diagnosticians can be right in their own ways, and it is necessary to join and complement their opinions to receive a complete picture. I think that scientific diagnostics is not a random and subjective game but rather the art of gathering in one, taking into account the opinions of all adversaries.

Subtle characterological diagnostics is the process of communication of the psychotherapist’s soul with the patient’s soul. The psychotherapist’s being is vibrating in response to the patient’s being. The psychotherapist listens attentively to the response in his or her soul and puts it into clear words, including terms.

Lived diagnostics is rooted through feeling into reality. It can err in formulating the diagnosis but will be right in understanding a person. And, vice versa, it may be possible to guess the diagnosis without understanding the person. The only way is to consider and feel the patient on the basis of one’s professional and lived experience and intuition, using one’s knowledge to help oneself.

I view diagnostics as a broader phenomenon than diagnosis, and I will explain my point using he metaphor of a tree. The trunk is the diagnosis, i.e., the character; the branches are variations within the character; the twigs are traits of individuality within the framework of the version of the character; and leafs are thin, emerging here and now, monetary manifestations of a person. Only the tree as a whole, from the trunk to the veins pertain to living diagnostics. Naturally, diagnostics is endless.

In a clinical existential approach, it is essential to distinguish between characterology and typology, Characterology is open to reality; it is related to knowledge as to important landmarks in understanding people. Typology replaces reality, hiding it from itself through a map of characterological knowledge of formulaic and logical acrobatics. No knowledge is worth losing touch with one’s intuition and experience.

The principle of setting and tuning.  Clinical knowledge is setting, while psychological one is tuning. The above is true in relation to the patients of a psychotherapist, that is, to people, with whom clinical knowledge is necessary.

I think that clinical and psychological knowledge may complement each other to a greater extent than is commonly believed. Through my own practice, I confirmed that a certain psychotherapeutic direction can be foreign to a person, yet individual elements from it can be used for the person’s benefit.

The principle of mythologizing the consciousness and psychological technologies. The consciousness is non-material, but this does not imply that consciousness cannot be altered. Psychological techniques are used to translate the unfavourable condition of a person’s consciousness into the favourable one and to retain the latter.

In clinical existential approach, it is essential that the transition from conversation to technique and the return from technique to conversation should take place naturally and smoothly for the patient. Certainly, the introduction of light trance is desirable for technical work. Trance leads to shortcutting the way between the psychotherapist’s words and the patient’s unconscious. I clearly understand that classical hypnosis is a viable and considerable aid for a patient, but I have certain spiritual reservations here. Deep trance entails the danger of replacing the patient’s reality by that of a somnambular – in particular, a patient’s freedom of will can be taken away, and I find it hard to accept it.

Sometimes a technical action arises spontaneously and intuitively. Knowing the purpose and mechanism of techniques, these actions can be prompted ‘here and now’, at the edge of the situation.

Techniques in the context of psychotherapeutic process. A psychological technique is a structured algorithm for action to change a person’s state. What is required for its cohesion? Techniques do not act in an abstract space: they are applied in the space of psychotherapeutic environment and contact, which influence a lot.

I will distinguish certain essential points. Much is determined by the patient’s trust. Also, the authority (but not authoritarianism) of a therapist will influence the extent to which his or her words will go to the patient’s heart and impact the patient’s unconscious processes. The magic of a psychotherapeutic contact can be so strong that the workshop of technical tools need not be opened.

(To be continued in the next issue)