Periklis Antoniou Photo Translation from the original Italian text by Stefania Elektra Pantavos
Bianciardi, M. (…) Sull’ insegnamento della pratica clinica. Connessioni, …:25-35
In this short essay I intend to explain why training for clinical practice involves an impossibility which cannot be avoided: a required impossibility, so to speak.
I think it is useful to address and explain this impossibility for two reasons. The first is more general: reflecting on the structural aspects of teaching clinical practice can help teachers and students become more aware of the path they are taking together (the process they both enter). The second is specific: I am convinced that those entrusted with the task of training in clinical practice should respect this impossibility with awareness and sincerity - and this is because it is intimately connected to what defines an authentic human relationship.
First of all, let’s think about the fact that training in psychotherapy cannot limit itself to learning theories, contents and techniques: it is universally recognized that a process of training in clinical practice implies something that goes beyond everything [presented as a theory or as a theory of technique] and constitutes the content of scientific texts or manuals. It is not from reading books that one learns to be a psychotherapist. Thus this simple consideration should be sufficient to make us recognize that this 'something' - which goes beyond what is said and written - is of primary importance in the formation of the future psychotherapist and hopefully, a central and inalienable aspect of the clinical practice. If we try to explain what appears to be impossible to 'teach' to the future psychotherapist, we could observe that it concerns the first-person participation in the meeting with the patient and therefore the management and monitoring of the ongoing therapeutic relationship. Also, it is based on personal history, the universe of beliefs and premises, human formation, the subjective experiences of the therapist himself/herself, and therefore it depends on the ability to engage his/her personality and emotions within the therapeutic relationship. Consequently, it is about the uniqueness of each person who addresses us and each psychotherapeutic meeting and therefore knowing how to combine a certain degree of consistency, flexibility, creativity and freedom to the clinical approach.
All this, in my opinion, cannot be transmitted, taught or “given” by the teacher to the student. On the contrary, we could affirm [even if this argument requires to be treated separately] that the inevitable phenomena of identification and imitation, even when involuntary, which characterize every training process in the initial phase, must be considered useful phenomena only when they are provisional. Phenomena that are to befaced, elaborated and overcome progressively, until the personal “style” of the training therapist is defined.
An embryo couple of concepts of second-order
In order to define more precisely what we must consider impossible to “transmit” or “teach” during the training process in clinical practice [an indispensable goal of this process] I propose using the following embryo couple of concepts of second order: “knowing to know” and “knowing not to know”.
I will explain in the course of the discussion the reasons why I believe these concepts formally express what we are talking about. For the moment, let's examine the concept of each term.
First of all, let's see in which sense these are second-order concepts. In the brief definition that von Foerster proposes, “Second-order concepts” are "concepts that apply to themselves". A concept must be considered second-order when it describes what happens whenever a logical operator operates on the results of that same logical operator, or when the same logical operation is applied at different levels: in this sense a second order concept describes a recursive operation. "In these cases the result of an operation is again subjected to the same operation, and we can talk about 'recursive operations’. The basic logical examples of recursion expressed by second-order concepts are: learning to learn, knowledge of knowledge, organization of organization, etc.
In the two concepts proposed [“knowing to know” and “knowing not to know”] the logical operator “to know” is present, or recurs, at two different levels.
In this sense these two concepts must be considered second order.
We will see later how the 'closure' that characterizes the recursive processes, as described by the concepts of the second order, implies the impossible logic of their transmissibility.
Let us now examine in which sense it is an embryonic couple. The concept embryo is placed within a logic of complementarity. As Varela has argued, classical logic is a logic that respects the principle of identity [according to which "A is not non-A"].
Within this logic, concepts are understood as part of the same plan and compared within a timeless dimension: therefore they tend to constitute pairs of opposites, or conceptual oppositions. In living and natural systems, however, what we can observe are processes that happen in time; and within these processes the conceptual opposites of classical logic can be understood as different aspects, but still mutually implied by the same process: as alternative points of view, as different levels of observation, as perspectives that arise on distinct levels, considering that is the same process that happens over time. Consider, for example, the classic opposition between 'symmetry' and 'complementarity' [and it is, if you think about it, just what we are doing at this moment in contrasting a logic of complementarity with a logic of the identity that is, in fact, a symmetrical logic]. Inside a classical logic the two concepts must be considered as opposed. One is the contrary of the other, one is the opposite of the other and excludes the other, one defines itself as the negative of the other [the 'symmetry' is defined as the opposite of 'complementarity', and vice versa]. Instead, when we observe any relationship between living beings [for example, to a couple of parents who recently consulted us], we make each other account that their relationship can [and probably must] be described as 'complementarity' from a certain point of view, but 'symmetric' from another point of view. In this case, symmetry and complementarity appear to us as distinct, but implicit, aspects of the same process: as different points of view for which to consider the same human relationship. It is then possible to understand in which way one aspect can be understood as emerging from the other: in other words, it is possible to understand how the symmetry can be considered the matrix, the condition, the horizon, of the complementary aspects of the couple, and how complementarity can be considered the context, the premise, the frame, of the symmetry aspects that the couple presents.
It is precisely in this sense, that the conceptual opposites of classical logic can be understood as distinct and alternative points of view, which generate and imply each other.
In general, two concepts can be considered linked to each other from a relationship of embryo in which they are understood on separate planes, in such a way that, from one point of view, one concept is born and emerges from the other, and at the same time, but from another point of view, the same concept it is placed as the matrix and the origin of the other. Therefore the embryo relationship is a reciprocal and complex relationship that intertwines planes, different and irreducible perspectives, so that each of the two concepts can be considered simultaneously - and in relation to the point of view - cause and consequence, figure and background, frame and element.
I will clarify how the two concepts proposed ['knowing to know' and 'knowing not to know '] can and should be understood as concepts that are embryonic.
Reflection on the procedures of knowing
With the concept of second-order 'knowing to know' we must refer to something more articulated, more dialectical, and even more specific. It is not the just being aware of having learned, and therefore to know a given content. We should speak, more precisely, of a 'knowledge of knowledge', or a knowledge related to the process of knowing, or to the operational methods according to which a knowledge is formed and stabilized in us.
Usually this level of knowledge is not necessary, and indeed, probably it would be bulky. Consider, for example, that even though we have all been taught how images are formed on the retina, when we 'see' an object or a person, we would not think about that mechanism every time we meet a person or hold an object.
However, the human being is characterized by the potential to contemplate upon himself and his own experience in the world: the human being reflects, which means literally, that he turns to himself the cognitive activity which specifies him as a living organism. The history of human civilization, in this sense, is the history of myths, theories, religions, and philosophies, which express and collect the reflections of the human about being a human. In this context we should reflect upon the fact that the human being constructs hypotheses concerning his own cognitive processes: philosophies are always also epistemologies.
Therefore, knowing, for the human, implies the possibility to know knowledge: it introduces a plurality of logical levels and inaugurates a recursive process. Human knowledge is characterized by the possibility [and therefore by the inevitability] of knowing about knowledge, or of knowing knowledge.
By this, I do not mean to support that the more elevated 'knowledge' [the first 'knowledge' within the phrase "knowing to know"] should be understood as somehow 'right' or objective: even at this level the person always constructs provisional hypotheses, which in the course of human history have constantly changed and evolved by forming an embryonic loop between the history of humans, on the one hand, and the history of ideas and theories of humans about themselves, on the other. I simply intend to remember that the human is a sentient animal for which the knowing implies and involves being able to know the knowledge; and the ability to reflect one's own cognitive activity [as it characterizes the being 'human' of human] must be considered indispensable within a therapeutic relationship. The latter, in fact, is characterized as an interpersonal meeting that aims to face a question that is not involved with, at least primarily, physiological or organic problems, or to problems which might be circumscribableor objectified. On the contrary, psychotherapy is defined as such when it addresses a question that concerns precisely that knot, though still mysterious, where word and viscera, physiological functions and emotional meanings, meaningful relationships and hereditary heritage are interlaced. A psychotherapeutic relationship, in other words, welcomes and addresses a question that relates to how the human knows the world by knowing himself/herself and knows himself/herself by knowing the world, or even how he/she experiences his/her own world reflecting on his/her experience of the world, and reflects on himself/herself in experimenting his/her own world. Although there is not enough space here to cover such a crucial and exciting issue, these brief considerations highlight how psychotherapy focuses precisely on the recursive loop we are talking about, and cannot therefore ignore a reflection on the cognitive processes involved in it.
‘Knowing to know’ means, therefore, to reflect on the modalities through which we achieve the knowledge of the other and the relationship we are building.
If we dwell on the term diagnosis [dia = through, gnosis = knowing], we are talking about knowing knowledge, which is nothing more than being aware of the ‘ dia’ that every knowing process involves. In other words, knowledge always takes place in any case through logical and emotional premises, expectations, prejudices, linguistic and conceptual tools, etc. and we should pause and reflect upon all the properties and characteristics through which we achieve knowledge.
Let’s consider two classic concepts in the history of psychotherapy: the concept of 'unconscious' and the concept of 'system'. The future psychotherapist will have to know the concepts, and will have to 'know' what the concepts are. He will have to learn, and therefore know, both the theoretical definition of the concepts and the epistemological and cultural context in which they were born, the history of ideas, the disputes, the clinical applications that derive from them, and their placement within the broader conceptual structure that they have which includes them. Besides knowing all this, the future psychotherapist must know what it is about: he/she will never have to forget, that the concepts are nothing more than heuristic instruments, explanatory principles, interpretative modalities, and therefore that they belong [with good intentions] to one's own mind and cognitive functioning, but they are not property of the other or of the relationship. The future psychotherapist will have to learn, little by little, not to confuse himself/herself with the other and not to overlap his/her cognitive tools to the 'object' of knowledge. The 'object' of knowledge, in reality, is an autonomous subjectivity that the psychotherapist [for logical and epistemological reasons, but also for clinical and ethical reasons] will still have to know how to consider 'other' and not knowable according to objectifying methods.
The concept of 'unconscious' and the concept of 'system' are useful and necessary. Therefore they do not describe the other , but our approach to the other.
This 'knowledge of knowing' brings with it, so to speak, the ‘knowledge of not to know '. In fact, if I am aware of the fact that my knowledge of the other is constructed and self-referenced, that it is historical and contextual, that it is local and temporary, that it is subjective and is contaminated, that it is hypothetical and is relative ... then I also know that it is based on ignorance. First of all, because awareness of the fact that the process of knowledge is constructed according to given modalities, based on given premises, and placing itself within certain methodological denominations, involves the awareness that my knowledge is given to the price of ignorance of what I could know according to other operational methods, within other theoretical frames, or starting from different premises. Not only that: the awareness of a self-reported knowledge allows an authentic respect for the other as an autonomous subject to be maintained, and as such unknowable. If indeed I know that my explanatory principles describe my approach to the relationship with others [and therefore talking about me] then I do not pretend to explain the other; I recognize that the other [in his/her own subjectivity, or in his/her own subjective description of the relation] will still remain an inexplicable mystery. As we will see - although briefly - subjective autonomy is the closure of recursive operations; it follows that the supposed possibility of considering such closure as 'explained' [literally, as 'open'] would logically imply the denial of the autonomy of the other.
The concept of 'unconscious' and the concept of 'system' do not describe each other, but they describe the cognitive modalities of the clinician. The clinician who knows the ‘system’ does not confuse and overlap himself with the other. Therefore, not only is he aware of his own ignorance, but also considers such ignorance as a gift for the authenticity of the relationship.
Classical psychotherapy and post-modern psychotherapy
The thoughts that have been developed so far address, at least apparently, a problem. Traditionally, the theories of psychotherapy have not underlined the importance of awareness we are talking about. On the contrary, born in the cultural climate of the late nineteenth century, theories have consciously pursued a classical scientific approach, tending to neutralize the subject in favor of a knowledge as ‘objective’ as possible.
It would follow that only psychotherapies developed within the cultural and epistemological awareness of the late twentieth century, would respond to that indispensable requirement of being a psychotherapist that I am proposing here; 'knowing to know' and 'knowing that I do not know', while the classical theoretical-clinical approaches [unless they have been later revisited] would exclude this possibility.
Obviously, a statement of this kind would be naive, and definitively contradicted what I am proposing.
First of all, we must stress that in the course of a relationship, the rational awareness of a clinician who is placed within a post-modern epistemology, does not guarantee the risk of not confusing the other with his/her own cognitive tools, and of not imposing his/her own reductive and naive 'maps' to the mystery of the relationship with the other.
On the other hand, I am deeply convinced that clinicians who follow classical theoretical-clinical approaches, know how to be flexible in the application of the method and theory of the clinic, and attentive to respect the non-reducible alteration of the patient, much more than many post-modern clinicians who explicitly apply their own epistemological awareness.
The discussion of this point leads directly to the conclusions of this essay, and the logical reasons for which the awareness that we are talking about cannot be taught: reasons that reside, precisely, in the 'closure' that characterizes the recursive processes described by the concepts of second order.
In order to better understand these reasons, it is necessary to distinguish the contents of a theory, and also of a clinical theory [which can be transmitted from the teacher to the student], from the way those same contents are assumed in first person and become alive in the cognitive, and clinical activity of the student.
Let us resume the concepts of 'unconscious' and 'system'. The theoretical definition of concepts can be taught: a theoretical content can be written in full, studied and learned. The teacher can also verify that the student has learned it correctly, and will do so based on the norm that the correct definition establishes. However, this does not mean that the student won’t integrate the theoretical content within his previous experiences and knowledge according to methods that are still autonomous and irreducible. The concept of 'system' as it appears in the definition of a book is a ‘dead’ concept, so to speak, or is a potential knowledge, at least until it is not assimilated, and therefore reinterpreted, by a single subject. The theoretical concept up to now written in a linear way, becomes then an operational concept that is in some way unique, peculiar to that single subject, unrepeatable, and always in progress. Ultimately, the concept as it is assimilated in an experiential way by the individual subject, never coincides with the theoretical concept that can be written, transmitted, taught and verified from the outside.
The critical awareness and reflection we are talking about won’t be reported by the concept written in a linear way but to a concept alive and lived, operational, subjective and temporal. Thus the recursion expressed by the concept of second order 'know to know' can only operate on the theoretical content as it was assumed, read, understood and interpreted by the single subject. It means that the teacher, or the written text, is no longer present in the recursive loop that the two levels of knowledge intertwine. The 'knowing to know' is the reflection on the subjective modalities to assimilate the content of a concept.
In other words: a first-order interpretation of the 'know' and of the 'knowing' [for example, knowing the exact theoretical definition of a concept as it is reported in a study text] implies a distinction and a separation between the one who teaches and the one who learns, between the one who dictates the norm of the right content of the 'knowledge' and the one that must learn. Instead, when the two concepts are applied to themselves and become second-order concepts, it happens that the teacher, the text [and the norm that they establish], are no longer relevant, and remain, so to speak, in the background, or better still, they leave the scene altogether. The subject in fact knows his own education, reflects on his own knowledge.
In the first case we consider the systems as heteronomous systems [it is the teacher, or the text, that establishes the norm of the correct definition of the concept]. In the second case we consider the systems as autonomous systems [the teacher leaves the scene, as the subject reflects on his/her own modality to assimilate the concept].
These reflections allow us to underline how the concepts of second order describe a recursion that must be understood as a closing of an autonomous loop.
This is the logical and formal reason why the 'knowledge of knowing' and 'knowledge not to know '[unlike a theoretical content] cannot be taught.
The knowledge to know does not have a content that can be supplied from the outside, but our own cognitive functionality, and ultimately us. Nothing new, which comes from the outside, is learned. It is becoming aware of how we are living organisms that we know and learn. The second-order concepts, are the concepts of autonomy, and imply and describe this 'closure'. They describe the properties that characterize living systems as autonomous systems: as systems that give themselves their own rules. Autonomy, by definition, cannot be either taught or imposed, or regulated from the outside.
Finally, for this same logical and formal reason we must not consider thatitis sufficient to refer to a constructivist epistemology in order to acquire, once and for all, the awareness that we are talking about [nor think, with a certain arrogance, that those who maintain themselves within a traditional epistemology cannot access the awareness].
Let’s reflect on the fact that second-order concepts are also concepts that can be written in a linear way [and it is exactly what we have done in this essay!], and then proposed in the form of theoretical content that can be learned. But of course, in this case, the concept of second order is objectified, placed outside of me, observed, transmitted, taught and learned. This theoretical learning lies precisely in a level of first-order knowledge [the student learns at the first level order, in a heteronomous way, a second-order concept, which describes autonomy]. It is well known that becoming aware of one's own operational mode is different from studying the awareness in books.
What I have tried to explain using a couple of second order concepts, is that it cannot be taught, and this is because it deals with reflective and re-cursory processes that are placed in the field of autonomy. If it could be taught, it would be something else.
However, it is possible and desirable to experience it. The future psychotherapist will experience it when he will be able to 'see' a patient as a 'phobic' patient for example, a couple as a 'symmetrical' pair, or a family like an '' enmeshed family ... and then jump out of this cognitive mode, allowing himself/herself to be amazed by the different and unique readings, peculiar to the single encounter and not repeatable. Nevertheless, it is necessary to highlight that the experience I am talking about is not simply abandoning an explanatory hypothesis in favor of another, in the hope that the second will result in something more 'correct' or more useful: in this case it would only mean replacing one ‘read’ with another.
The subjective experience of 'knowing to know' that no one will ever teach is that the clinician can say to himself/herself: "It's me that I have in mind the 'phobia', the 'symmetry', the ‘entanglement’...!"
The teaching method can create a relational and experiential context that can facilitate the possibility of this experience. I think this happens, for example, when the teacher has a coherent attitude that is not instructive in the clinical setting [never saying what should be done, what is needed to say, etc.] but instead to place himself/herself in a position of listening to his/her younger colleagues: a teacher who honestly listens to the student and his/her way of understanding and explaining the clinical situation, a teacher that shows himself/herself genuinely willing to learn from the student, probably creates the conditions for the student to have the experience of listening and learning from the patient, recognizing that their explanatory concepts do not describe the other, but speak about themselves.
It will be in the solitude of the relationship with oneself and in the mystery of self-awareness that someone will temporarily experience, with fear and trembling, the knowledge of knowing and the knowledge of not knowing. However, it will not be an experience that can be owned. The awareness we are talking about cannot be achieved all at once and cannot be considered given and definitive. This is because the omitted reflection on our cognitive processes and the juxtaposition of our actions in order to discover the external reality, are adaptive and intertwined processes of our living by knowing and knowing by living. Observing our personal explanatory principles from the outside and distinguishing them from the mysterious encounter with the other, is therefore a bit like jumping out of ourselves.
When this happens we can recognize it as a gift of the relationship.
 Von Foerster, Heinz. (1985). Cibernetica ed epistemologia: storia e prospettive. In: Bocchi, G. & Ceruti, M. (eds). La sfida della complessità . Milano: Feltrinelli, p.116.
 Ibidem, p. 127. As von Foerster himself reminds, the study of recursion has been formalized in mathematics, from the ‘theory of recursive functions’.
 As we know, there are theoretical-clinical approaches which aim, among others, to the client acquiring an increased reflective capacity on his/her own psychological processes. Other approaches do not have this goal, however, in any case the clinician’s cognitive stance, in my opinion, cannot develop regardless of a reflective attention. On the contrary, the psychotherapeutic encounter is in danger of being reduced to a simple confrontation between two world views that are posed and maintained on the same logic plane.
 See Bianciardi, 1999.
 “An essential condition for a system to be closed is that the ‘end’ of a domain must coincide with its ‘beginning’”. (von Foester, 1985, p.125)
Bateson, G. (1969), Mente/Ambiente, in: Bateson, G. (1991). _Una sacra unità. _ Milano: Adelphi.
Bianciardi, M. (1999), Autonomia del vivente e criteri diagnostici. Connessioni, 5:…
von Foerster, H. (1985). Cibernetica ed epistemologia: storia e prospettive. In:
Bocchi, G. & Ceruti, M. (eds). La sfida della complessità . Milano: Feltrinelli.
von Foerster, H. (1987). Sistemi che osservano . Roma: Astrolabio.