Wednesday, December 29, 2021

Therapeutic stance in person-centred psychiatry

Laura Galbusera et al (2021) discuss the importance not only of the personal but also of the interpersonal dimension for person-centred psychiatry. It builds on her paper (2019, with Miriam Kyselo). which sees openness and authenticity as the characteristic principles underlying the therapeutic stance, integrating professionalism into a relationship with the patient. As Adolf Meyer said a long time ago, psychiatry needs to accept its inherent uncertainty (see egs. my article and previous post). The self is social and relational, not a single, egocentric entity. As I've said before (eg. see my article), human cognition needs to be understood in a dynamic, integrated, enactive way as it is embodied in the brain and the body more generally, and embedded in the environment, which is social and cultural, affording various possibilities of action to the organism. Such a view is consistent with Engel's biopsychosocial model (see eg. previous post)

The stance a professional takes therapeutically is an expression of their personhood. Relational psychiatry is the application of the person-centred method in psychiatry (see egs. previous post and another). As Galbusera et al say:

according to [Helmuth] Plessner’s concept of 'eccentric positionality' – which for him is a defining feature of personhood – we are positioned both within and without our own being and are hence capable at the same time of experiencing the world from a first-person perspective and of taking the point of view of others (ie. the third-person perspective) toward ourselves. Personhood consequently is a category that unifies the dichotomy of individuality and sociality by mediating our individual being with social norms and expectations and vice versa.

Openness and authenticity are necessary not only within the clinical domain but also at a societal level in the treatment of those with serious mental illness as persons (see eg. another previous post).


(with thanks to tweet by James Barnes @psychgeist52) 

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6 comments:

  1. cobweb30 December 2021 at 11:25

    Duncan

    On a non academic level I would like to point out how bizzare the actual encounter with a psychiatrist (and other health workers) can be. In no other situatin is a person expected to meet and talk with a complete stranger about intimate parts of their life while he/she sits on the other side of a desk taking notes which are not shared. If that could be changed to make it a less stressful encounter it would be a step forward in humanising the relationship. For example take a walk and talk together would be a step in getting to know - each other. Susanne

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    1. DBDouble2 January 2022 at 12:23

      I suppose professionalism does need to integrated into the relationship, Susanne.

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  2. Eric Setz30 December 2021 at 17:44

    Does this approach mean that the therapist fits his theories to the patient rather than expectingthepatient to fit his/her theory?

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    1. DBDouble2 January 2022 at 12:22

      I supose it’s not necessarily psychotherapy/psychoanalysis

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  3. Eric Setz4 January 2022 at 04:25

    The trap with the professional relationship is the ontologically insecure patient is thrust into the role ot patient which leads to rebellion and/or instituationalism.
    When the subject of beingness comes up with a patient I reasure them that they can work it out and I advise them that whatever they decide they should owen it. My own lack of persistence was my weakness.

    Eric

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  4. DBDouble4 January 2022 at 17:51

    Maybe, Eric. Psychiatry does need to change though.

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