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Emotional security and its role in psychotherapeutic relationship.
центр позитивной психотерапии, позитивная психотерапия, Максим Гончаров
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One of the reasons for the existence of different models and methods in psychotherapy is the absence of sufficiently convincing criteria of effectiveness between different methods.

Many authors emphasize, that still it is not clear how the changes have been made by psychotherapy. There are big varieties of effective influences which effectiveness is often not noted and is not taken into account. That’s one of the reasons why general factors become the subject for special interest of researchers.

The main force of different directions of psychotherapy is “psychotherapist – patient” relationship system. Interpersonal interaction between the patient and the therapist has become a central place in understanding of psychotherapy. The idea of influence has been changed by the idea of interaction.

The healing factors of therapist personality

Resent research has showed that most important variable in psychotherapy is not the technique but the human instrumentalities through which the technique is implemented - the psychotherapist.

In 1947 American Psychological Association’s Committee on Training in Clinical Psychology have suggested 15 characteristics for good therapist. Then after R. R. Holt, L. Luborsky (1958) this list made wider to 25. Effective therapists usually have good mental health & effectively deal this their own problem.

The emotionally safe atmosphere (emotional security).
Lots of authors emphasize the importance of emotional security in psychotherapy. Without a safety the personality development is not possible. Safety is one of characteristics and criteria for functioning. The safety may be different: physical, intellectual, legal, financial, organizational, governmental and so on. Central in safety theory is a threat. 

In this investigation the safety called emotional because it is limited by therapist-patient relationship and appears in ability of the therapist to take care of the patients emotions.

Each individual seeks a central relationship in which to find security, satisfaction, and meaning. To make the patient feel safe is more important then to wait for insight by interpretation. J. Weiss (1993) tells, that «first task of psychotherapist – is to help the patient feel secure». If these communication skills have provided an adequate respect, information and overview, they provide for a sense of safety and trust. Safety is the feeling experienced when you know that one’s boundaries will be respected, that you are regarded by others with caring, and that you have sufficient information about an event or person to predict possible futures. Feeling safe with someone, you can risk revealing the aspects of yourself with which you are uncomfortable so as to examine then with him or her.

Indeed, J. Kottler notes that majority of the psychotherapist pay a lot of attention to the process of making secure and convenient atmosphere in which the client could try new ways of functioning. Making atmosphere of security and emotional support in communication with the patient, psychotherapist provides patient with mechanism of identification which decreases uncertainty, increases self-confidence through unconscious borrowing therapist’s strengths, optimism and ability to cope with the difficulties. Professional psychotherapist can create an atmosphere, where the patient would feel himself being in security, accepted and understood.

Therefore, an emotional safety atmosphere is a special type of emotional relationship between the patient and therapist. This is not only the threat absence. It is more condition of psychological comfort & emotional security; support in which the patient can remain himself in communication with the therapist, where patients resistance gets lower; his self esteem keep adequate and self exploration in psychotherapeutic process gets higher. With the aim of establishing an emotionally safety relationship the therapist needs to provide a certain capacities and also to create an atmosphere where the patient can develop them in him self.

On the basis of different researches we have chosen 9 criteria that are needed to establish effective emotional security atmosphere. It is laid on the personality capacities of the psychotherapist, which were recognized in psychotherapy field as necessary condition for creating “helping relationship”.

1.     The capacity to understand someone emotions (empathic understanding)

2.     The capacity to listen others (empathic listening)

3.     The capacity to stay in contact with own emotions (congruence)

4.     The capacity to transfer emotions constructively (verbalization)

5.     The capacity to focus on the future salvation of the problem, to see a chance (hope)

6.     The capacity to see someone resources (faith)

7.     The capacity to set freedom to respond (trust)

8.     The capacity to give someone time (time)

9.     The capacity to stay patient (patience)

Now in details:

1.    The capacity to understand someone emotions

Substantially this capacity connected with empathy or empathic understanding. There is unanimous understanding that empathy is one of the most important elements in psychotherapy on each stage.

Attention to emotions is one of the most important resources in psychotherapy. It is one of three Rogers conditions in client centered psychotherapy for constructive personality changes.

The empathic understanding is not a result of intellectual efforts. The empathy depends of availability and wealth of someone’s subjective experience, accurate perceptions, ability to tune on the same wave by listening. This quality of our psychic is peculiar to everyone, but developed differently. Wolberg L. (1977) emphasizes, that it can be developed wider then it was before. As more person is able to empathize, as higher his ability to help other people in concrete situation. The development of the empathic potential is really determining the effectiveness of interpersonal communication with the patient. Also, empathy by it self has antistress effect.

2.    The capacity to listen others.

One of fundamental skills of the therapist is productive listening. Such listening is more then passive fixation. It is dynamic readiness which includes main feelings modality, intuition, reflection and especially developing empathy. The big part of the session the therapist’s attention must be directed to main task: to listen what the patient is telling. The sheer act of talking can provide an individual with considerable emotional palliation. It furnishes a motor outlet for the release of tension. It softens and liberates conflicts that have been held in check. It exposes suppressed attitudes and ideas that person has been concealing, and it encourages the individual to subject these to the light of critical reasoning. When S. Freud has stopped practicing hypnosis and switched to talking cure, he has discovered that the chance to talk about disturbing problem makes patient’s state better, because it liberates suppressed mental energy.

3.    The capacity to stay in contact with own emotions (congruence, genuineness).

The therapist must build an interpersonal relationship taking into account his own spontaneous feelings and associations. Patients do not remain therapist’s emotional reactions without an attention and respond to it.

The capacity to stay in contact with one’s own emotions is called congruence. The congruence means necessity of truthful symbolization one’s own experience. According to D. Gоleman (1999), congruence is one of the most important capacities which compose emotional intelligence.

4.    The capacity to transfer emotions constructively (verbalization).

The therapist has to be able to convey to the patient the information he has received from the patient. The therapists’ capacities who can only understand but not to convey are limited. It is very important for the therapists to be able verbally formulate those feelings and symptoms, which have been ignored by the patient or he is not able to talk.

«Accurate empathy» includes ability to understand feeling & ability verbally convey to the patient in understandable way. It called verbalization. Verbalization means exact verbal description of the patients’ emotional content.

5.    The capacity to focus on the future salvation of the problem, to see a chance  (hope).

This capability substantially connected with hope. Psychotherapeutic investigation show that the central question for the therapy is does the patient see the therapist as supporting and encouraging factor. Any kind of psychotherapy includes supporting components. Support – is naturally and essentially result of good therapeutic relationship. Our attitude to the future, which improves truly importance of the present events and its relativeness – is the hope. Here hope presents as an acceptance of the possibility to achieve the goal and changes.

The hope is needed not only for keeping patient in therapeutic process that gives opportunity to act other therapeutic factors. Hope and believe by itself has a therapeutic effect.

6.    The capacity to see someone resources (faith).

Substantially, this capacity is linked to the faith and therapist’s conception of man. Believes of the therapist in patients capacities in this context is same as scientific hypothesis for researcher. For effective work psychotherapist must follow clear personality theory and general conception of the therapeutic process. The patient will get helped if he has enough faith in therapist. In case if the therapist is in doubt his pessimism may discharge faith of the patient.

To the basic kind of human nature belong that someone action and motives are determined not by the reality but the imagination about the reality. Therefore, in spite of objective truth that every human being has inalienable value, the person who does not realize it deeply behaves him as he does not have it.

It is very important to convey to the patient that he possesses his own capabilities and strengths. «Ability to accompany patient and to encourage his resources of self help means trust to recognized resources of the patient and knowledge how to support with involving social groups.

7.    The capacity to set freedom to respond

Substantially, this capacity connected with trust and love. The patient let himself be himself, think, feel and react without limitation and also openly speak and relieve. Psychotherapist encourages freedom to respond that leads to release emotional catharsis. The term of С. Rogers (1957) «unconditional positive regard» — means, that psychotherapist respect the right of the patient to stay him self, but do not have to agree and approve all the patient do or say. If psychotherapist accept the patient as he is and this acceptance colored with warmth and respect it helps the patient regard him self the same way. Such respectful and careful attitude without blaming and suppressing a will makes psychotherapeutic situation safe and helps the patient feel more positive and illuminate inner barriers, which prevent active participation in the treatment process.

8.    The capacity to give someone time.

Every person has his own temp of life and surely his own temp of changes. Ignoring this leads to anxiety, feeling of lack of interest, lack of hope and unsafe. Effective psychotherapy mean by moving with the speed of the patient without imposing owns temp. Every one needs time to integrate new knowledge, collect courage and begin experiment with new type of behavior and learn to take adequate decisions, go trough the resistance and foolish fears. Also, the time means ability to dispose the past, present and the future.

9.    The capacity to stay patient.

The content of this capacity is patience, tolerance. Effective psychotherapist is able to provide enough patience, suppressing own needs to see the signs of progress. To accept a person as it is with its capabilities we need a lot of patience. This patience appears in ability to promote gradual growth of the patient capabilities and to “endure”, recognize uniqueness of the partner despite of doubts and disappointments. The patience is the same as ability to wait, to prolong satisfaction of desires, to content with partial success and to set a time for development of other capacities. The patience is readiness to give time for other. Some times it means an ability to abstain from the actins.

 Reference:

1.     Аннелизе Хайгл-Эверс, Франц Хайгл, Юрген Отт, Ульрих Рюгер: Базисное руководство по психотерапии – Восточно-Европейский институт психоанализа, Издательство «Речь» 2001. стр.783

2.     Вайнер И. Основы психотерапии. 2-е международное издание. «Питер» 2002, 288 С.

3.     Вайсс Д. Как работает психотерапия: Пер. с англ. – М.: «Класс», 1998. – 230 с.

4.     Вид В.Д. Параметры психотерапевтического процесса и результаты психотерапии// Обозрение психиатрии и медицинской психологии им. В.М. Бехтерева. – 1994 (2), С. 20-21

5.     Дж. Бьюдженталь. Искусство психотерапевта. 3-е международное издание, Питер, Санкт-Петербург. 2001- 294 с.

6.     Котлер Д. Совершенный психотерапевт. Работа с трудными клиентами. «Питер», Санкт-Петербург. 2002- 350 с.

7.     Пезешкиан Х. Позитивная психотерапия как транскультуральный подход в Российской психотерапии: Дисс. в виде научного доклада на соискание учёной степени доктора мед. Наук/ Санкт-Петерб. НИИ им. В.М. Бехтерева. - СПб, 1998. – 83 с.

8.     Психотерапевтическая энциклопедия/Под ред. Б.Д.  Карвасарского - СПб: Питер, 2000. – 752 с.

9.     Психотерапия: новая наука о человеке/ Под. ред. А. Притца. – Академический проект, Москва 1999, Деловая книга, Екатеринбург 1999.

10.  Томэ Х., Кэхеле Х. Современный психоанализ: Пер. с англ.: В 2 т. - М.: Прогресс – Литеретура – Яхтсмен, 1996

11.  Bastiansen Stein. Psychotherapy and autonomy of the individual//What is Psychotherapy? S.Karger-Basel-Munchen-Paris-London-New York-Sidney 1975, p. 399

12.  Frank J.D. Common features of Psychotherapies and their patients//What is Psychotherapy? S.Karger-Basel-Munchen-Paris-London-New York-Sidney 1975, p. 370

13.  Gomes de Araujo H.A. What is Psychotherapy//What is Psychotherapy? S.Karger-Basel-Munchen-Paris-London-New York-Sidney 1975, p. 449-454

14.  Handbook of family therapy. Volume I. Edited by Alan S. Gurman, Ph.D. and David P. Kniskern Psy.D. Brunner/Mazel, Publishers. New York 1981. P. 796

15.  Lewis J.M For Better or Worse: Interpersonal and Individual Outcome. Am J Psychiatry 155:5, May 1998

16. Wolberg l..R. The technique of psychotherapy. Grune & Stratton. New York-San Fracisco-London. Third addition. 1977