Re: Construing Psychotherapy Outcomes and the Role of Persuasion

Ana Catina (catina@Psyres-Stuttgart.DE)
Wed, 17 Apr 1996 19:02:55 +0200 (MET DST)

Dear John,
I read and read and read again your message. I think that you have
already evaluated correctly the effectivity of your intervetions: lower
rate of hospital recidivism, medication compliance and the shorter
community stays. I asked myself about how your clients would rate their
state when they go away? Probably they are not aware if they have learnt
something useful without having some time to test this usefulness. Do you
consider useful what you attain with these people? It is diffcult for me
to understand if you doubt the values you offer as alternative of
construing, ie the goals you feel being imposed with? How would it be without learning
these alternatives? Try to picture their perspectives.
What do you thik we try to convey to our own children? I should say: look
here are
the requirements one has to respect (not comply, please) in order to to
have the liberty to look for some own ways. Find the way you want to deal
with them - but be sure you can cope with all consequences created by it. Be
sure you anticipate the result of your choise. It takes us years as
parents to do this, you have only moths perhaps. Is the principles the same?
Have you thought about
your own alternative goals of your activity? What would you wish to
convey to these people instead?
Understanding your client probably means more than understanding his
construing, or respecting his/hers believes; it can mean for instance
taking an active stance toward their sufference, ie
helping him/her out from a situation that borught him/her to you and
probably caused a lot of suffering. What goals would you choose if being
on your own will, what goals dictated by your common sense, not by
theories? Compare your own goals with the imposed ones and try to
negociate with your self and your clients.
For instance you are asked to teach them independence: you consider it
unwise and not desired by your clients. Dependence is not a solution, is
it? Do they still have somebody to depend on trustfully? If not can you help
the construing of independence as part of relating to others, to help
them not to exclude human affiliation, not to preempt and discard certain
forms of dependency?
Medication with side effects: could you work without it? In order to
apply therapy (often) you need your partner (client) in a state of "ready
to take contact". Are they able to open to your intervention without
medication? Are they obliged to take medication for very long? I have
this experience with other kind of clients, and I learnt to compromise
when i know that medication is the way to obtain the entrance on the
same wave length. Some of your clients, I imagine, are probably not ready
to accept contact, or to loose their construing that due to the situation
can be extremely tight.
I unfortunatelly think that learning to enrich the
self with some
education is helpful. Even working might give the self a sense to exist
for. Ask the unemployee.
I cooment these goels sometimes even playing against my convinctions
because I have the feeling your construct on them is very negative. I
mean constricted. May be I am wrong. Reading the end of your message it
occurs to me that in your situation I should take for granted that being
a PCP psychologist for a very long time, I became a PCP human being: I
should not bother if I respect its postulates, since I have no other
philosophy of living - it is in me, in my construing about it and the only
thing I have to do is to do my best to help - I should be very sure that
my help is along with my thus aquired philosophy about living. You do a
job I think. Your job I is to help your clients adjust to the
socially negociated conventions: it is a phase in their life. I think
that you can not change as much as you imagine; They probably "learn"
only what can be accomodated to the existent construct system. They will
discover other ways or ideas for themselves at another time points of
their life and possibly discard yours. At that time point they will be
more ripe or eady, or able to do it. But now it is important that they come
out from the situation they are in and that probably allow them only
other varians of preemptive construing without any social validation.
Is the social validation that premerge our adjustment unimportant? I am
not deadly sure.
Yes, the end justify the means in this case - but once more, your means are
the best one can
implement in such a situation! The lack of time - you are the beginning:
can you build a network to support them after leaving your community? I
mean like the liassons in psychotherapy? A network with people to follow
the same methods you apply? It is a hard job, you are doing and a very
important one for those you try so hard. Sometimes one can reproache
oneself the whole life for not having been manipulative enough in certain
circumstances that could have given a better course to the life of an
other one.
Dr.Phil. Ana Catina
Center for Psychotherapy Research
Christian Belser Str. 79a
70597 Stuttgart

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