Showing trust in the client’s ability to heal is of significant value and is done by addressing the spiritual part of the client.
By Roberto Assagioli, undated, From the Assagioli Archive in Florence, Doc. #19938 – Fragment – See Notes in Archives [1]. Original Title: Commenti sulla Tecnica di Henri Baruk su il Rapporto fra Psicoterapeuta e Paziente. Translated and Edited With Notes by Jan Kuniholm
In his Traité de Psychiatrie[2] Prof. Henri Baruk describes his main technique in treating psychotic and psychoneurotic patients. He emphasizes a group of techniques concerning the psychotherapist’s attitude, his preparation and his relationship with his patients.
The first and most general task of the psychotherapist is to become fully aware of the overall influence that his personality — or rather that he as a human being — exerts on the patient. This happens spontaneously, naturally and inevitably; but he then moves from this spontaneous and unconscious influence to a conscious and well-regulated one. Furthermore, he eliminates those aspects of it that may be harmful or create an obstacle to treatment, accentuating or developing certain influences that are constructive and helpful if they are absent. This point has been considered by other psychotherapists, e.g., by Alphonse Maeder[3] in La Personne du Médecin – un agent psychothérapeutique[4] and by Wilhelm Tochtermann[5] in Der Arzt als Arznei.[6]
Baruk’s specific technique is based on his fundamental conception that in every patient, including severe psychotic cases, behind the pathological facade of symptoms and disorders, there is an aspect that remains immune to them, the characteristic feature of which is moral consciousness. He has dealt with this in several of his books, and has given satisfactory evidence of the reality of his conception. See, for example, Psychiatrie Morale Expérimentale, Individuelle et Sociale.[7] Accordingly, Baruk in his therapy addresses the healthy aspects of the patient, and especially addresses his moral conscience. He indicates his procedure with a word he coined, chitamnie, which means, according to his interpretation, “the method of trust;” that is, trusting the patient.
This was and is of particular interest, because for many years I myself used a similar technique, independently of Baruk. In psychosynthesis, however, the emphasis is not on the moral conscience, but one addresses the whole better part of the patient, with the same spirit of trust and appreciation that Baruk speaks of. Placing and demonstrating trust in the patient has yielded very satisfactory results.
This was done specifically in serious situations, such as that of patients who had attempted suicide. In such cases, the usual procedure is to provide for the patient’s safety and to safeguard his own responsibility by having him admitted to a psychiatric hospital. Instead, I dared not to do that, and instead spoke to the patient in the following terms, “You are aware of the seriousness of what you have done. Professional practice, and in a sense my duty as well, would be to provide for your protection through admission to a specialized hospital. But I would be willing to offer you another alternative. If you gives me your word of honor not to perform any other act against yourself, for a specified period of time (usually a month or, in more serious cases, a week), I am willing to begin intensive psychotherapeutic treatment with you. You are well aware of the serious consequences for yourself, and also for me, if you make another suicide attempt during this period. So if you feel that you have sufficient mastery over yourself to give me your word of honor not to make any further attempt for this short period of time, I will take the risk. At the end of this period, you will have sufficient knowledge of psychotherapy and the general possibilities of treatment to judge for yourself whether you feel able to renew your commitment, or if not, to go voluntarily to a clinic. There the treatment could continue, but you would be protected from outside against your self-destructive impulses.”
In all cases where this method has been adopted, the result has been positive. Of course, during those periods the treatment was intensive, with one session a day, or every other day.
This fact of the psychotherapeutic relationship is fundamental in psychotherapy, and only a hint of it has been given here, whereas instead it deserves thorough examination and the use of a whole range of appropriate techniques. Obviously, in this respect the personality of the psychotherapist is one of the most important elements.
In America, Rogers[8] strongly emphasized the importance of trust in the patient’s ability to direct certain positive and constructive forces, and he appeals to these. However, in psychosynthesis one is not limited to a purely “non-directive” method such as his, because for the development, regulation and harmonious integration of psychological energies, the teaching and use of various active techniques are necessary. In addition, the role of active counselor has a constructive effect in interpersonal relationships. This should be a function equivalent to that of a “wise father,” who has won his children’s trust and respect by example and with answers to their spontaneous questions.
The father’s function is to offer guidance that can [help one] avoid many mistakes and misunderstandings, thereby shortening and smoothing the path leading to the development of an autonomous personality in children. In some respects, the mother can also perform this task, especially with daughters, helping them to understand their appropriate feminine functions; but this requires that the mother herself has actualized her role and is adequate to the task.
Referring again to Henri Baruk’s methods, we can observe that sensibility, or moral conscience, is a direct characteristic of the spiritual Self, but it is not its only one. Therefore, the psychotherapist, in addressing the better and higher part of the patient, while taking full consideration of the moral aspect, should not limit himself to this alone, but also appeal to the other transpersonal aspects and activities which he has dealt with in the previous chapters. Moreover, the Baruk method requires of the psychotherapist not only a great deal of patience, attention and interest, but also a great deal of time. It is therefore necessary not only for the psychotherapist to assume this attitude of trust, but also for all the people who deal with the patient during treatment. They should be taught to take the same attitude in order not to undo what the psychotherapist tries to accomplish; they should be asked to cooperate actively with him, to help him create an atmosphere of trust in the patient. Therefore, all the time devoted by the psychotherapist for this purpose — for the preparation of family members and of nurses or other assistants — will be well spent. This preparation of nurses or other caregivers is also useful not only for current patients, but also for all those whom psychotherapist or caregivers will have to deal with later. This is increasingly being recognized, and interesting experiments are being made in “therapeutic communities.”
There is one point that needs clarification; and that is that there are different levels of moral consciousness, and it is important to distinguish between them. On the one hand, there is the moral consciousness that Freud referred to by the name “super-ego,” which is largely derived from prohibitions and parental commands. This type of “conscience” is linked to intense emotional charges, such as fear of doing wrong and guilt for every transgression, and consequently is harmful. This type of morality, produced by introjected external influences, is rigid, strict and intransigent.
In contrast, the moral conscience that is an expression of the transpersonal is completely different: it is benevolent and understanding toward self as well as toward others, and its highest manifestation can be said to be expressed in the words of Christ, “Love your neighbor as yourself.” Therefore, this type of moral conscience is not rigid, does not adhere to specific codes of conduct, but is inspired by essential and universal ethical values.
This distinction must be kept firmly in mind in order to avoid the repressive moralism against which psychoanalysis and the modern world in general have reacted, often in a violent and extreme way. Its[9] elemental manifestation, which has been well highlighted by Baruk, is the sense of justice. Baruk says that even in the most seriously ill patients this sense of justice endures. Many violently ill patients are infuriated because of real or perceived injustices of which they feel they are the object, even if they are very small, since these are symbols of injustices they suffered in the past. Baruk, in dealing with such patients, examines them carefully and thoroughly, and gets very good results from this. He has compiled a test for the sense of justice which, using a Hebrew term, he calls the “Tsedek-test.” It was described in his book Le test Tsedek, le jugement moral et la délinquance.[10]
[1] The Archives contains a note that this document is an “incomplete text found on the back of doc. #19937.” —Ed.
[2] Treatise on Psychiatry, Paris, Masson, 1959, Vol. II, by Henri Baruk (1897-1999), French neuropsychiatrist. —Ed.
[3] Alphonse Maeder (1882-1971) was a Swiss physician, psychiatrist and therapist who worked with Bleuler, Jung, and Freud. Assagioli probably knew him personally. —Ed.
[4] The Person of the Doctor – A Psychotherapeutic Agent (Neuchâtel, Delachaux & Niestlé 1953). —Author’s Note.
[5] Wilhelm Tochtermann (1912-1972), German psychotherapist and author. —Ed.
[6] The Doctor as Medicine (Dustri-Verlag, Remscheid-Lennep, 1955). —Author’s note.
[7] Moral Experimental Psychiatry – Individual and Social, Paris, Presses Universitaires de France, 2nd Edition, 1950. —Author’s Note.
[8] Carl Rogers (1902-1987) was an American psychologist, one of the founders of “humanistic psychology” known for his “person-centered therapy.” —Ed.
[9] i.e., this reaction. —Ed.
[10] The Tzedek Test — Moral Judgment and Delinquency, Paris, Presses Universitaires de France, 1950. —Author’s Note.
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