Ricerca in Psicoterapia. Presentazioni ai Congressi, 4: Shanghai, 2014

Il Centro di Psicoterapia di Roma si occupa anche e soprattutto di Ricerca in ambito psicoterapeutico e, come già, presentato in precedenza (;;;), riteniamo che sia importante la condivisione delle riflessioni che emergono dalla clinica per crescere e portare avanti un pensiero comune sull’essere umano come linea guida della Psicoterapia.

L’obiettivo è che i diversi orientamenti teorici partano da una base che è la Fisiologia Umana per rivolgersi ai pazienti e aiutarli con la cura o il supporto adeguati alla specifica situazione.

Per questo motivo il Centro mette a disposizione di tutti il materiale presentato nelle sedi dedicate alla Ricerca.

21° Congresso Mondiale di Psicoterapia IFP (International Federation for Psychotherapy).

Shanghai, 9-11 Maggio 2014.

Title: Psychotherapy: relevance of therapeutic alliance and dreams for patients’ recruitment.

Presenter: Michele Battuello.

Many patients present complex clinical features and symptoms that make difficult the evaluation for a psychotherapy.

Initial sessions are usually focused on exploring patients’ inner world, relations, history and psychopathology and the therapist tries at his best to understand what’s going wrong with that person.

No doubt that this is a good and valid clinical practice but we think that is only a partial knowledge of the patient. The psychotherapist can decide to start a psychotherapy basing only on dysfunctional aspects. This limits the possibility for a psychotherapy because the seriousness of symptoms and pathological dynamics is the distinctive element that allows to work with the patient or not.

So often “severe” situations are subjected to a psychiatric evaluation and to a pharmacotherapy and follow another clinical path while less severe patients can start a Psychotherapy.

Our clinical practice starts with the assumption that the beginning of a Psychotherapy is strictly related to recovery’s possibility and that pathological aspects are not enough to comprehend the patient as a whole.

This approach follows an accurate medical vision: as for the body we start from the physiological elements that constitute the sanity, the same we think for the mind. What happens in pathology and also in psychopathology is that something broke down and the clinician has to provide to rebuild the physiological structures, in a simple word, recovery.

We understood from more than 10 years of experience that what we are looking for and have to find is the valid and functional part of the patient considered as unconscious skills. Unconscious is not intended in a psychoanalytical view but as everything that is latent we could say non-conscious.

Since first sessions, our proposition is explicit with the aim of activating an answer that is reachable by dreams and by relation. Patients usually concentrating on their symptoms, problems and conflicts in a circular loop with no way out, find a different perspective, an explicit request to work with the aim of let emerge what we call the human potential as a special quality of human being that I’ll better describe this afternoon.

The relation becomes quickly strong for many reasons:

  1. A proposition of therapy where is considered recovery’s possibility.
  2. A proposition of searching not only the pathology, the “bad” parts of the person, but mostly the valid, affective and functional ones.
  3. A proposition of leaving to the patient the time he needs to become an active part of this work.

Dreams usually bring images of conflictual and psychopathological issues but also the human potential we are looking for as I’ll show later in my discussion with some clinical examples.

Just because we consider this initial phase of therapy so important, number of evaluation sessions can be variable up to 8 and more, as the patient’s answer requests. The efficacy of this method is evaluable soon.

The valid therapeutic alliance that appears as the answer to therapist’s proposition, represents the  awareness of patients that we could call the “physiological” elements, the not destroyed ones, that are still present.

They can be covered by symptoms, by pathological dynamics, by severe illness, but they can be still present in traces and when patient can reach them, is an indication for beginning a Psychotherapy and a positive predictor factor for recovery.

We work with combined individual/group therapy.

Individual therapy deals with symptoms, intra-psychic conflicts, and private issues. Meanwhile the therapist develops relational capacity of the patient and extends therapy’s work to socio-cultural aspects, allowing him to enter group therapy. We continue, at the same time, with individual and group therapy, for a time different for each case. Then therapy continues in the group only, until its ends. The duration of the three steps is variable, but the total amount of time of the therapeutic approach is reduced by half in 10 years.

Today’s symposium concerns about interpretation of dreams and so I prefer to discuss with you about some dreams I have choose from initial evaluation’s sessions.

Dreams are observed as spontaneous activity and as reaction to therapist’s work.

Interpretation of dreams:  C., Female, 40 y.o., precedent diagnosis of Bipolar D., second evaluation’s session:

“She returns in the house were she lived since 11 to 24 years, that hates and hated. She takes a look at it and thinks that she had needed to go away to understand how beautiful it was. So she opens windows and on the terrace meets a man that tells her that is a good place and there it will be possible to organize many parties”.

the interpretation of this dream concerned what I was just talking about before: personal history and family dynamics especially with the mother were really conflictual; a mother completely non affective, a family system completely based on material and practical aspects. When during first sessions I proposed her to see what in this terrible mess was her strength, her spontaneous activity of loving her family anyway as the human potential of every baby, she had let emerge this image. It concerns also with another basic assumption of our methodology: the necessity of separation from what didn’t work as pathological dynamics, to activate the unconscious skills. These are represented as a beautiful place to share with a man and with friends.

Fifth evaluation’s session:

“In a shop there are many clothes for her very beautiful but too expensive. She thinks that she can buy only the baby’s ones (3-4 y.o.) for her baby that is coming or will come soon.”

this dream confirms the fact that even if  she can’t find her identity, she unconsciously understood that the base for its reconstruction is in the time where she was completely intact. Her awareness emerged as the answer to my proposition: the goal of our therapy will be the realization of the human potential of the 3-4 y.o. baby she is waiting for. We call this period the psychic weaning process.

M., male 36y.o., precedent diagnosis of Bipolar D., second evaluation’s session:

“He works as a barman in a private yacht, he’s happy to meet an old girfriend of primary school’s period. She has a small black dog funny. Clients leave for him 5 euro’s tip and he’s happy because it’s money he can spend for himself.”

 the patient tries to go back to find in his memory an affective relation of the past, and this allows him to find unconscious money for himself to work in psychotherapy.

Eight evaluation’s session:

“He’s swimming in venice’s lagoon with many turtles. Turtles sometimes breath out of the sea as he does. He sees on the seaside his girlfriend with two children (6-8 y.o.) that play with turtles.”

even if his pathological issues are severe as symptoms, he finds the possibility to move between conscious and unconscious easily, and this allows him to find his valid, affective and functional parts.

S., female, 18 y.o., with a structured personality of rigorousness, very practice and material, high mind functionality, one day completely stopped her studies with consequently depression, anguish, fear. She was sent to me from a colleague with who she had one session.

2nd evaluation session:

“she was on the terrace of a small house and in the ground she sees a beautiful, big horse. She’s on the stairs and she finds in her hand a leaf and she has to decide if giving it to the horse or not” (she will explain that the leaf is the same of the plant of my studio).

During the 1st session, I explained to her that my interest was not to resolve immediately her symptoms and her fears because now they’re an important skill to say that something’s going wrong and maybe must be changed. And this was the unconscious emerged sign of a good therapeutic alliance.

3rd evaluation session:

“she arrives in a high building with her friend, she has to come in the apartment of a woman to show her friend the wonderful terrace of that woman. But while she’s going in, she finds an upper floor and they go there. There lives her professor, serious, a bit strange, but she likes him and he has a great house and also a wonderful terrace. She brings her friend to the terrace also because it was a good place to see the terrace of the woman and while she tries to show it to her friends, when she turns to her, she transforms in a rook and flies away”.

“she wants to exit from a building, and outside meets her friend with her mother and her sister. Her friend has long, thick and maybe sick, legs and she’s astonished of that”.

These two dreams represent the unconscious awareness of patient that found something special in the similar proposition of the 2 therapists but at the same time, where she understood that she found the great terraces where the rook can fly away, she finds the trust to offer her pathological dynamics to the therapy.

So this explicit proposition to patients of looking for the human potential creates a spontaneous answer of a valid therapeutic alliance represented by a strong relation and dreams. When this potential emerge as the trace of what has not been destroyed but kept valid we can be sure to start a psychotherapy and consider it as a good predictor factor of recovery.

Title: Psychotherapy: emerging human potential together with the resolution of unconscious conflicts.

 Presenter: Michele Battuello.

Individual therapy deals with symptoms, intra-psychic conflicts, and private issues. Meanwhile the therapist develops relational capacity of the patient and extends therapy’s work to socio-cultural aspects, allowing him to enter group therapy. We continue, at the same time, with individual and group therapy, for a time different for each case. Then therapy continues in the group only, until its end. The duration of the three steps is variable, but the total amount of time of the therapeutic approach is reduced by half in 10 years.

Our general approach to the patient is strictly medical: we consider the human being as a whole, in terms of body and mind. This whole has a physiological integrity. When this integrity is assaulted, there appears the pathology.

In the etiology of psychopathology what is assaulted is the psychic integrity of the baby, represented in its excellence by the baby born. In the adulthood every single lesion of this whole can present as pathology, as dysfunctional dynamics and relations and/or symptoms.

Aim of the psychotherapy, as of the medical clinician is recovery, in other word rebuilding the physiological integrity, the functional whole.

For this reason, we explain a diagnosis to the patients, because it contains the explicit proposition of recovery. Diagnosis doesn’t mean a label, a stigmatization name, but a concrete element, emerged by relation and dreams that explains what we have to look for and resolve during the psychotherapy. The patient is completely involved and called for activating in this proposition at the same time of the therapist. Furthermore the communication of a diagnosis  has dynamic relevance: it changes with the prosecution of psychotherapy as the conscious and unconscious dynamics change.

A proposition of recovery doesn’t contain only the resolution of inner conflicts and the elaboration of psychopathological dynamics but also and let me say, mostly the realization of unconscious skills. This unconscious for us is not represented by the removed but by everything that is latent, non-conscious. Psychotherapy deals also with the establishment of a valid thought and a correct relation with reality.

The valid elements represented with the relation and dreams, is what we call the Human Potential.

We consider life’s period since birth until 3-4 y.o. an extremely powerful but also a fragile time for the human being.

Where from one side there’s all the potentiality of the baby as a specie-specific factor of humans that must be expressed and invigorated by affective and valid relations, on the other side this potential can be assaulted by the outside.

We have also understood that if the first 3-4 years of life are kept valid, we can be quite sure that the bases for a functional identity are built and there will not be the possibility of a severe psychopathology during adulthood except for serious life’s experiences as trauma.

The baby has well completed what we call the psychic weaning and he has ready the inner tools to face problems, dysfunctional relations and pains that he will physiologically meet in his life. This process will continue until adolescence: at that time everything kept valid will be integrated in the adulthood identity.

In psychotherapy the human potential emerges as traces of every valid moment in relations that the patient experienced in his life and protected and kept intact.

Every time he will invest this human potential in relations or what else affective activity, this will be a valid moment, it will be left in traces in his unconscious memory establishing his inner time and his identity will grow up.

What has been assaulted and the baby couldn’t save as a whole, in adulthood could manifest dysfunctional dynamics and psychopathology. We call assault all that in the affective relation proposition doesn’t answer to the baby’s spontaneous, physiological requests. He will feel it in a crescendo sense of discomfort, emptiness and anguish.

In more than 10 years of clinical experience, we found that obviously psychotherapy must be focused on psychopathological aspects of the patient, as on symptoms and inner conflicts but this must be related to an explicit, direct proposition of researching this human potential. During first sessions, or evaluation sessions, as I explained this morning in another symposium, the therapist proposes this research as an important part of the therapy.

This usually creates a fast answer of the patient that emerges from the relation and dreams, what we call a valid therapeutic alliance. The relation is strong indeed we have no relevant drop out but an active participation of the patient to therapy. On the other side, dreams shows together with the conflictual and pathological dynamics, the appearance of the human potential as valid and affective images.

Our methodology of psychodynamic psychotherapy is based on interpretation: of dreams and of the relation.

So interpretation assumes a combined role during therapy.

Interpretation comprehends both the frustration of pathological issues as the strengthen of valid parts emerged as manifestation of the human potential.

For all I have explained before, the therapist must propose both his presence and affectivity both the knowledge of physiology: to offer an image not destroyed in the transference process but also to sense what has to be reinforced by the therapy because valid, intact, powerful despite to what must be frustrated because it’s fragmentation, broke, assaulted and pathological.

Consequently patient’s history is redefined in its sense and not only in its facts.

Advancing the psychotherapy, the human potential appears the more the defense mechanisms break down. It takes shape mostly from dreams: all the identity’s construction traces represent the unconscious memory as a representation of well organized inner time.

Dreams that show images of conflicts, empty, death represent everything that hasn’t been built and so the pathology.

Concluding, progressive emerging of human potential deals with the aim of psychotherapy: a progressive affective and thought autonomy of the patient. It contains the complete identity rebuilt and the meaning of finding the psychic weaning of 3-4 years of  life.

Let me propose you a clinical example: a man, 34 y.o. his relation with the mother is clearly explained by the following dream during 5th month of therapy, only individual.

I was 6 y.o. more or less, when I was living alone with my mother in Africa: from the bedroom, I go into the living room, the TV is on and I see my mother speaking from tv. I feel desperate because I couldn’t communicate with her.

In his life, an important affective role was played by grandparents, and represented by many dreams containing the beach house where he spent lots of summers with them.

The following is a dream of nearly 1 year of therapy, attending combined individual/group therapy.

I’m on the terrace of the beach house, I see a big off road vehicle trying to go away passing through a small path and stairs: in a difficult way but it goes away. At this time I see males faces arriving, they’re discussing about mafia. Then I see myself at about 12 y.o. running through the terrace in another terrace where there are my grandparents in a swimming pool with a big window opening on the seafront.

The patient realized a weaning, a separation from the big, bulky mother, allowing him to see a male image even if he doesn’t like it yet. Then thanks to this separation he finds his human potential, invested in the affective relation with grandparents that allows him to open his eyes.

After another year he recently dreamt, in group therapy only and closing to the end of his psychotherapy:

I was as I am today, I was elegant dressed with my case and I was in my grandparents house: it was beautiful but it was the time to leave it and I was happy closing the door back to me.

This represents the effective beginning of recovery that is realized with the definitive, complete autonomy from the therapist.


Michele Battuello

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