The incidence of the therapist's self in the therapeutic process

The style of this work is to rate the incidence of the therapist style in the psychotherapy process. We define the concept of therapist style as the habitual patterns, unique to each person, that are related to the vision that has of himself and the world, his beliefs, life experiences, evolutionary moment he goes through, socioeconomic position and his style affective. A high similarity in the belief system between the patient and the therapist can cause a stagnation in the treatment, as well as a dissonance can lead to the abandonment of the same.

In PsychologyOnline we explain the details about the incidence of the therapist's self in the therapeutic process.

Index

1. How the therapist works best
2. How Therapist's Self Experiences Affect Therapy
3. Other studies on the self of the therapist in the therapeutic process
4. Summary

It is essential that the therapist has a space for supervision and training in order to address the following items:

1. Increase their theoretical knowledge, acquire and strengthen a theoretical framework of reference necessary to identify and guide the therapeutic process.
2. Acquire a wide range of techniques that can be implemented in psychotherapy.
3. Develop internal skills that allow you to use your personal experience, and challenge the dysfunctional beliefs that act as an obstacle in your work.
4. Ability to interact and coordinate own therapeutic efforts and with other professionals - doctors, lawyers, psychopedagogues - in order to have a broad and comprehensive vision of the patient.

Being able to adequately work on these points provides the therapist with a greater repertoire of resources and favors obtaining more flexible and creative behaviors.

To what extent can the therapist who is experiencing severe depression be effective in his therapeutic work? How would it affect a Jewish therapist to treat a patient with Nazi ideas? Is it possible for a therapist with principles and values ​​of justice to treat a murderer? In short, can a therapist care for a patient with beliefs that are very opposite to his own?

We could also ask ourselves about the influence on the results of a treatment when a therapist has suffered a disorder similar to that of his patient and has managed to overcome it. Consider, for example, the case of an ex-addict who coordinates therapeutic groups with people suffering from addiction; Does this increase the credibility of patients in their therapist?

Next we will try to link this class of questions with the person, or self of the therapist, taking the contributions of authors from various theoretical currents who have investigated this topic, in order to integrate their ideas in the elaboration of this work.

According to the vision of Fernandez Alvarez (1996) it is possible to conceive of the “style” of the therapist with the constant, habitual and unique ways of being of each subject that comprise a series of factors such as: your ideas, beliefs, life situation, life experience, interpersonal relationships in general, position socio-economic, social sphere, affective style, religion, emotional and cognitive processes, their own history, world view, flexibility, etc.

In all the psychotherapeutic approaches there is a common element, since the therapy is known by people and the therapeutic relationship, in so much bond that is established between patient and therapist, it is the bond to reach the goals traced.

In general, within the therapeutic community, there is a marked tendency to locate, adhere to, and in some cases take certain currents as dogma. psychological, acting as an obstacle to regenerate other possible approaches and / or alternatives to understand and help patients to alleviate their suffering.

There is no doubt that the more solid the theoretical knowledge, the greater the range of techniques that it handles. the therapist and, the better he detects what happens to the patient, he will be able to perform interventions more precise.

However, we must emphasize the leading role that the personal style of the patient plays in the therapeutic process. therapist, since as has been shown through meticulous investigations, it has a high incidence in said process. All this leads us to think that the most important instrument of psychotherapy is the person of the therapist, as Sadir said (1958 P.63).

From his investigations, Frank (1985) list a number of factors that lead to success in psychotherapies:

• The ability of the patient to feel understood in a climate of trust and hope;
• Quality of the bond between patient and therapist
• Acquisition of new information, which allows greater learning possibilities;
• Emotional activation (where empathy, acceptance and authenticity are characteristics of the therapist that accompany this process);
• Increased sense of mastery and self-sufficiency.

On the one hand, it is evident that patients tend to obtain higher results when assigning credibility to the psychotherapist from the beginning and, on the other hand, it is essential that the therapist be able to harmonize empathically, putting himself in the place of the patient, in his framework of reference, in their culture, in their customs, their beliefs, their values, their way of perceiving the world, establishing harmony with it on a verbal level and not verbal.

Likewise, Beutler (1995) demonstrated in his research that the person of the therapist is eight times more influential than his theoretical orientation, and / or the use of specific therapeutic techniques.

Baringoltz (1992 B) intensely developed this theme, posing the following questions: What determines that some patients awaken in therapists different behaviors, emotions and thinking? Why are professionals more comfortable with some patients than others? The answers to these questions are related to the paradigm of psychotherapists and their personal style.

At the same time, it is worth asking whether, since there is still intense agreement in the cognitive styles of patients and therapists, this could produce a stagnation in psychotherapy.

In this regard, Baringoltz (1992 a) states: “significant consonances between the belief systems of the therapist and the patient, or a high degree of complementarity of the themselves, causes stagnation in treatments, as well as significant dissonances cause lack of empathy, rejection, irritability and frequent abandonment of the treatment".

As an example, a demanding therapist who cares for a patient with perfectionist ideas about how to work; Could it cause a stagnation in the therapeutic process? Given that both would have the same conception about the modality of how to work, would it be more difficult for the therapist to make the patient's ideas more flexible and generate alternatives? Or, could this be an opportunity that makes it easier for the therapist to review his own ideas and that, therefore, induces him to grow to change with the patient?

In research conducted by Orlinsky; Grawe; Parks (1994) it was found that in 66% of the cases considered, the therapeutic link is strongly associated with therapy success, and that the therapist's contribution to the bond is related to success in 53% of patients themselves. Aspects of the therapist that have contributed to the effectiveness of the treatment include the ability of the therapist to: conceptualize the case, choose the strategies of the appropriate treatment and implement them at the right time, producing assertive interventions in treatment plans consistent with their guidance theoretical. We emphasize the importance of the therapist feeling comfortable and secure with the frame of reference and the techniques that he uses.

Other studies such as that of Williams and Shambless (1990) demonstrated better results in the therapeutic process when patients perceive their therapists with a high level of trust.

From the perspective of J. Bowlby (1989), the therapeutic relationship is not only determined by the patient's history, but also emphasizes the history of the patient. therapist, who must be aware of his own contribution to the relationship in order to act by building an attachment bond insurance. Broadly speaking, attachment theory starts from the premise of an innate tendency, typical of human nature, to establish emotional ties intimacies with other individuals, a tendency that later becomes organized as attachment behavior and is maintained and preserved throughout the entire life. lifetime. The establishment of such emotional ties points to the search for protection, comfort and support in another person who is supposed to be the provider of said care. Although there are multiple possible combinations between the different types of attachment, it is the responsibility of the therapist to be able to detect them and introduce them into the therapeutic work. It should be noted that it is difficult to achieve a successful performance, if he has not previously gone through the experience himself the object of his own explorations. This is referring to the fact that the therapist has as a previous task and continues the review of his own attachment relationships, while Emotional communication with your patient will play a decisive role in the therapeutic work of restructuring the operant models of the patient. Therefore, let us observe that both aspects, personal and theoretical-technical, must be integrated in order to be configured as conditions of possibility for therapeutic work.

From the cognitive approach, Beck (1983) raises the importance of a bond of acceptance, empathy and authenticity. Beck defines acceptance as “sincere concern and concern for the patient that can help correct certain negative cognitive distortions that the patient patient contributes to the therapeutic relationship ”, and adds that the determining factor is not the real acceptance, but the perception of the acceptance that the patient has of their therapist. People are more likely to cooperate when they feel that their beliefs and feelings are understood and respected. This author defines empathy as "the best way for the therapist to enter the world of the patient, see and experience life as he does." This facilitates the manifestation of feelings and cognitions by the patient and therefore favors therapeutic collaboration. Finally, Beck postulates authenticity as an essential element in the therapeutic relationship that must be accompanied by the ability to communicate his sincerity to the patient. In summary, this author, regarding therapeutic interaction, emphasizes trust, rapport and collaboration.

In relation to the training of the therapist, we find the contributions of different authors that are of interest to the enrichment of professional practice and that make it possible to obtain more reliable results through Of the same.

Psychoanalysis was the first approach that I included in his professional training, the need for a process of self-knowledge of the person of the therapist, he emphasized the patient-therapist relationship as a vehicle of treatment, establishing the need for didactic analysis for therapists.

Freud (1933) theorized about transference and countertransference. He understands countertransference as the "unconscious feelings" related to the unresolved neurotic complexes of the analyst. Originally for Freud the solution for countertransference was analysis. In this sense, Freud reviewed the requirement of self-analysis, as the continuous process of working on oneself for analysts.

Both the Philadelphia family therapy training program (Harry Aponte) and the one designed by Joan Winter (both representatives of the systemic perspective) agree that a therapist is more effective when he uses himself to achieve the evolution of both his patient and his own person. Satir (1985, P.3) proposes three main objectives:

• Reveal to the therapist the source of your old knowledge and your worldview.
• The therapist's development of the knowledge of her parents as people beyond the role of parents.
• Help the therapist develop her point of view and define himself.

“The decision of a therapist to focus on his personal life or his therapeutic work varies, but he is supposed to examine both fields during the period of said training, since both internal and external ability, as well as theoretical and collaborative solvency are instrumental for the creation of competent professionals " (Satir, 1972).

The training program called “the person and the practice of the therapist” emphasizes four essential conditions that the clinical therapist needs to achieve a positive therapeutic result (Winter, 1982 P 4). The areas are:

• External possibilities, the actual technical behavior used by the therapist in managing therapy.
• Internal skills such as the personal integration of the therapist's own experience to become a useful therapeutic instrument.
• The theoretical capacity, or the acquisition of theoretical models and frames of reference, necessary to identify and guide the therapeutic process.
• The ability to collaborate, or the ability to coordinate one's own therapeutic efforts with those of other professionals or agents, including doctors, teachers, lawyers, other therapists, etc.

Although all the conditions presented are fundamental, given the limitations that we have in the extension of this work, we will focus on the center of attention on the person of the therapist and the therapeutic relationship, which we understand as the fundamental variables of the process therapeutic.

The proposal of Gallacher (1992 b) from a cognitive perspective, which develops Sara baringoltz, is group training based on therapeutic supervision. Training through the group device favors the deployment of different perspectives and points of view in the face of the problem presented, reaching an amplified and enriched vision of both the patient and the therapist paradigm. In addition, it acts as a space of containment and support for the therapists, favoring the patient-therapist relationship. They are supervisory because the patient's problems are analyzed and strategies are developed to solve them. Finally, they are therapeutic because the belief system of the therapists and their interaction with the patient are analyzed, looking for a making them more flexible, allowing the detection of the therapist's schemes and dysfunctional beliefs that could obstruct the development of the therapy.

As an example, a recently received therapist cared for a family whose identified patient presented various difficulties in the social area. After 2 weeks, the mother told the psychologist that she did not see great changes and she did not know what to do with her son; for her "it was all wrong." Faced with this approach, the therapist asked herself: why am I not achieving great changes? Could it be that I don't serve as a professional? Am I in the wrong profession? Faced with these questions, a therapeutic supervision group tried to challenge these distortions cognitive: questioning the evidence: What makes you think that from a single patient you do not serve as professional? Was there no change? For whom are they big and for whom are they small?; through reattribution: could it be that the expectation of that mother was very ambitious? Could it be that this lady, by expecting great changes, cannot see those that are small but still important? value?, examining alternative options: every claim of a patient to hope for something better, is it a failure of mine (therapist)? Does this only happen to me?

This allowed the therapist to examine and analyze her cognitive distortions leading her to obtain a broader view of the situation, significantly affecting the development of the process therapeutic. “The therapeutic supervision group is a path towards enriching the therapist's personal meaning, a reflective-experiential space is opened in where therapists find a place different from that of individual supervision, including the analysis itself, becoming aware of their own dysfunctional beliefs and their connection with unrecognized emotions that allow greater growth both professionally and individually (Baringoltz 1992b)

Feixas; Miró point out that the conception of the therapeutic process depends, to a great extent, on the psychotherapeutic model that is adopted. The constructions of the patient and the therapist configure meanings that facilitate, hinder or stop change. Minuchin (1986, P.23) from the systemic perspective, states that there are many family therapists who, despite using magnificent interventions, they are incorrect when they are not related to the understanding and basic needs of the family.

For Lambert (1989) “the psychotherapist is an important factor in the process and result of psychotherapy, the influence of the therapist remains significant even in studies where professionals have been selected, trained, supervised and monitored to minimize differences in their practices".

In order to synthesize, basically the training requires theoretical practical training, since the theoretical constitutes the frame of reference for the understanding of the singular modes of process the information of each patient and guide the operations for the change through different techniques. However, the therapist's exaggerated control and dogmatism are also considered to disturb his flexibility and are predictors of poor outcomes. On the other hand, a more flexible and open attitude is related to positive results in psychotherapy.

In consecuense, the therapist's person is involved in the bond and the reaction of the change; therefore, it is necessary to work on clinical materials in supervisions, attend conferences, conferences, congresses, etc. Baringoltz (1992c) says "it is essential to focus on the characteristics of the therapist's cognitive sense that act at the intersection of their own beliefs with that of the patients"

Given that the therapist, in general, assumes a commitment to psychotherapeutic work, his therapeutic instrument is his own person, it is fundamental that he then has a space for teamwork, where he feels content and accompanied, his person working as a therapist and that of his pairs. Likewise, the fact of having spaces for recreation, rest and implementation of humor has considerable value, which produces relaxation and greater effectiveness in its therapeutic work.

Finally it is relevant that the therapist has creative training, including self-observation and his own internal experiences.

To conclude, due to all the questions raised above, we have decided to focus this work on the person of the therapist. We believe that despite the large number of investigations on the subject, much remains to be investigated.

This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

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