HE.S.T.A.F.T.A. - Scientific Society of Mental Health Professionals


  • Katia CharalabakiPsychiatrist, Family Psychotherapist, coordinating director of Family Therapy Unit of Attica Psychiatric Hospital

It is a very original book, which in short, is about “play therapy”. It combines theory with psychotherapeutic practice and, above all, with experiences - of children, of the elderly, of men, of women, of patients and therapists.

I have no experience with play therapy (although I learned a lot from the book), so I will be a "stranger" in a "dialogue" (as a reader and now as a book presenter) which can, however, help make me, and hopefully, all of us together feel, , more intimate towards it.

The book proposes a card game that provokes associations and concepts. So, like "cards", some concepts worked for me, helping me talk through my personal professional history.

I will mention three points that I gleaned from the book, and link them to my own psychotherapeutic experience.

1.   Self-knowledge

In the book it says:

"Dogmatic madness, dogmatism madness." (p. 10)

"Psychotherapy must be the field that allows the mind to examine its transformations." (p. 12)

I would add: A relationship is always the result of a double description (G. Bateson).

Here we can refer to a "fictionalization" of psychotherapy, through thoughts developed by the great Russian linguist Mikhail Bakhtin:

We are talking about the concept of the “polyphonic self”, which signifies a transition from understanding the self as a closed system, to shaping the relational self, through a continuous internal and external dialogue, through questioning, reporting and integrating elements of other selves. Thus, we are talking about a psychotherapeutic process that has no ready-made solutions but is incomplete, uncertain, open to challenges, painful but also hopeful. Psychotherapy could be likened to a "fictionalising" process, where the writers, therapist and patients, approach together the reality of an intersubjective construct, which is open and in progress (just like a game), without the "epic" distances of finished and completed theoretical principles.

Of even more interest is the transfer of "fictionalization" into the dialogue between psychotherapeutic schools: In this dialogue, different approaches tend to abandon jousting, like knights with each other, but instead examine their deepest struggles, their imperfections, the partiality of their truths, the future, which is open to questions and to new answers.

This is exactly what this book does when it connects Freud, Jung, Cohut, Bateson, Watzlawick and others.

But that's exactly the central function of a game…

2.   From Narcissism to Reality

"The transformation of my narcissistic momentum into a real sense of personal worth does not stem from moralistic humility, but from the warmth of understanding at the moment of defeat. We know this by the more technical title of ‘empathy” (p. 15). I would add: "But also from the warmth of understanding ourselves and others at the moment of victory, through the winner's empathy for the loser."

Speaking of empathy, we can refer to Aeschylus' Persians:

The whole tragic venture of the tragedy presents the concept of "empathy" (a deeper understanding of the "other"), which in this case translates as a human familiarization of the winner with the loser’s feelings. Indeed, the "context" of the play is impressive, brave and magnificent. The winners (Athenians) mourn for the losers (Persians), they experience the foreign pain and act it out.

Additionally, the concept of empathy refers us to Melanie Klein's notions of "envy and gratitude". In the "paranoid-schizoid" position, the infant wants to "drain" the mother's breast, control and "suck", thus destroying the mother - the "other". If it remains in this position as an adult, he will be an envious, militant man, without love and concern for the good of others.

However, Melanie Klein described that the baby would later have to go through the "depressive position", through which it would recognize the mother - the other - as a person who it could love and care for. This means it will become an adult who has embraced the notion of diversity, solidarity and humanity.

In the "Persians" we see the victorious Greeks in the most mature "depressive position" one can imagine, since they care for and sympathize with their own enemy in the war.

It is a brave - moral and cultural - transition from narcissism to the reality of humanity.

** 3. Rituals, Symbols and Possibilities for Symbolism**

The term "rituals" is mentioned on page 17.

"Our era has been emptied of the rituals that have given us space to connect with what we cannot otherwise explain."

Here, I will say that there are many definitions of rituals in social anthropology.

It is a "Special sequence of actions that seals a change in the life of the individual / family / group".

It has a clear start, structure, and sequence of actions, organized around a theme, which is often repeated.

It may signal the end of one phase in life and the beginning of the next, or it may promote a change, such as problem solving or trauma healing.

Rituals have a formal and experiential side.

The symbol is the basic, fundamental unity of a ritual. Symbols have the ability to contain multiple meanings, to be associated with disparate phenomena, and to work simultaneously on the sensory and cognitive poles of meanings.

There are three main stages of rituals: Separation, Transition, and Reconnection.

In this sense, psychotherapy is a ritualistic process.

Most importantly, as the game book teaches us, the symbol is its core meaning.

"The symbol is the best possible expression of something unknown" (quoted by Jung Lexicon, p. 18). "In analytic psychology the nature of the symbol is understood by comparing it with the signal." "For the signal, the meaning is socially agreed upon and therefore it is clear. On the contrary, if we want to orient ourselves with the help of the symbol, the meaning appears when we consider the situation, the links between the various elements and the personal importance we attach to it."

With regard to symbols and symbolism, I will express some thoughts from our own psychotherapeutic work with families.

The key element of our day is the association of the socio-economic crisis with the rapid decline in people's ability to symbolize.

The intrusion of external reality elements into the therapeutic context is something that the therapist not only cannot ignore, but must use within the therapy. Very often we realize that family members have lost the ability to symbolize. They talk about money, food, material goods and time, per se, ignoring what all these represent (e.g. "You give to me”, “You deprive me of”, “You decide on your own without asking me”, “We don't communicate and we don't decide together" etc). For example, a couple strongly disagrees about an event where the husband refused to give his wife some money and the fight is over whether the amount was 3 or 5 Euros. They are screaming at each other, "You are lying!"

A second element is the "adaptation" of symbols to a reality that violently invades homes and forges the symbols of individuals or families, according to its own specifics.

That is, there is a resonance between the developmental phase of the family and the crisis in the wider context. What we see is that the invasion of social destabilization in the family context is not only quantitative but also qualitative. For example, those who did our training at AIA (AKMA), know about the "target child" and the "child refuge". When the teenage daughter feels the tension between her parents, she enters the room shouting at her father: "I'm going to the party whether you allow me to or not!"  "No, you're not going to go," the father replies, starting a fight between the father and daughter, thus the fight between the parents is avoided. The daughter gets the tension focused on her, becoming the "target child". Then the youngest son will approach the mother holding a scrabble box and say, "Do you want to play?" That way, he comforts his mother by becoming a "child shelter".

Today, elements of the deterioration of the social value system are entering family relationships. Thus, the teenage daughter (the target child) is not just disobedient or aggressive but also "self-serving", "exploitative". And the younger son, (the child-shelter) is not only a consoler but also an "informant", a "snitch" or a "rat". All of these are analogous to representations of the social and political system in the way that the family signifies them.

One conclusion, here, is that the therapist needs to protect the therapeutic framework, the "as if" function of the framework, so that it will not to be inundated with external reality, but at the same time he must be more solid and psychologically resilient to this invasion, enduring a tougher "holding" of their clients.

He must be a point of reference, of stability and security for the whole family. He must also try to overthrow the "linguistic tyranny" (which in society is totalitarianism) of the parents’  narrative (the daughter is the self-serving, exploitative - the son is a snitch, a rat). He must manage representation and instigation, reinforcing the I-position and two-person dialogue. He must link the “here and now” with history. And most importantly: To restore the capacity for abstract thought, prioritization, distinction, differentiation, symbolism as well as meta-communication and meaning construction.

"Playful mood is the experiential way of embodying our personal mythology in the present," say the authors of the book (p. 18).

I agree! So let's look for our own personal mythology in a playful way.


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