Translation: Paraskevi Bassioti, MSc Counselling Psychology
My decades-long contact with a great number of professionals in our field has offered me the possibility to observe the phenomena and the trends concerning the role we play in contemporary social reality.
I would thus like to express some thoughts and viewpoints that emanate from my experience in the mental health field that I have served for decades through my theoretical, research, therapeutic and educational activity.
In the contemporary world where everything expands, evolves or changes at a continuously accelerated pace, we are called upon to open our wide-angle lens in order to see the larger picture. What are we going to see if we direct this lens and open it towards the mental health field and towards ourselves, the professionals of our field?
The Mental Health Professional’s Continuously Growing Scope
The complexity and the instability of the contemporary social reality are mirrored in the impressive and continuously growing scope and the differentiations that characterise the role of the mental health professional. Our interactions with an increasing number of social groups build bridges that connect us with the economy, health and education.
The time when mental health professionals dealt with vulnerable social groups has gone by. Today, men and women, children, families and social groups that face the familiar and generalised problems of our era, for example, troubled relationships, family problems, personal dilemmas, turn to us. In other words, an increasing number of people experience and realise the mental and physical cost of personal and collective impasses and seek guidance, often more promptly. The greater the circle of social groups that ask for help from professionals of the field, the more indistinguishable the demarcation line between prevention and therapy.
My own therapeutic experience has shown me that it is more and more frequent over the last years for parents to openly express their concern about the impact their own difficulties may have on their children. As far as the children are concerned, they have also realised the grownups’ problems. I recall a conversation with a junior colleague who was recently hired at a private school’s Counselling Service. She told me that Secondary School children would knock on her door, and to her question “How can I help you?” they replied:“Tell me how I can help my parents”.
But, aside from the constantly increasing number of professionals who undertake to help individuals, families and wider social groups, there is also a rise in the professional groups, services, centres (businesses, educational organisations and nursing institutions) that turn to us for guidance, personnel sensitisation and executive training. The mental health professional, therefore, is increasingly called upon to collaborate with and train an increasing number of other professionals.
Legal and Ethical Dilemmas
Under the circumstances that have been created, the challenges for mental health professionals in general and for psychotherapists specifically are great. In our daily practice, we are faced with unprecedented situations. We encounter transformations and frequent distortions at all levels of social life, and we are called upon to function within a hodgepodge of rearrangements and revisions. The inversions and rearrangements that we face in our everyday practice raise fundamental questions and create multiple legal, ethical and therapeutic dilemmas.
The choices and negotiations about what is functional, right, fair and feasible clash with established meanings that no longer apply, are confused with the new perceptions under construction and inevitably create inconsistencies, dilemmas and differences of opinion. These intractable practices create internal and interpersonal conflicts, not only to those that come to us for guidance but also to us.
New Forms of Symbiosis
At this point, it might be worth focusing on the overwhelming changes regarding the basic social cell, the family. A key finding is that the crisis in family is now concentrated on its core, the man, the woman and the couple’s relationship. The strongest the hesitations, the more instant the centrifugal forces. Crises explode more and more frequently without notice, increasingly earlier. At this point, the couple’s relationship resembles a boiling cauldron. Marriages fall apart like houses of cards. An institution identified with the creation of family and man’s purpose is turning into a relationship characterised by an impressive instability. Marriage is turning from a lifelong relationship to a temporary, increasingly short-term symbiosis.
The mosaic of contemporary families includes every possible variation and endless combinations. A decision to divorce turns everything upside down. Individuals that until then belonged to distinct and strictly defined family patterns are intertwined, ramified and lead to new complex networks. Mixed, joined families emerge in record time as the dominant form of family. More and more people are now members of a mixed family. An increasing number of children will be members of a mixed family while still in adolescence.
Amidst these fundamental changes, it is not surprising that contemporary couples who decide to live in precarious constructions are in panic. They resemble a building’s tenants who are aware of its poor antiseismic specifications and prepareto abandon it before an impending earthquake.
I quote some examples from the recent therapeutic crop:
– One week after the birth of their child, Catherine finds an intimate text message on Christos’s mobile phone.
– John and Lena break up only two months into their marriage over a “trivial” pretext.
– Georgia, carrycot in hand, opens the door and walks out of the brand-new apartment they had been furnishing since the time they were living together.
– Shortly after her marriage, Loukia begins to meet the man she had broken up with a few months before marrying John.
– Spyros and Loukia’s marriage is hanging by a thread. They have daily arguments over Loukia’s frequent outings with her attractive manager who drives her to and from work.
– One week before the couple’s visit to his parents’ house, Despina finds on her mobile phone an intimate message from one of the couple’s common friends.
– Andreas and Irene’s two-year relationship suddenly falls apart, only days before they were due to move to another part of the country where Andreas has finally landed the job he had wanted for a long time.
These premature outbursts that explode suddenly and increasingly earlier are often more like early warnings. Parents interpret such hasty moves as youthful irresponsibility. According to the standards of their time, a mature behaviour would mean to maintain the relationship at all costs. But the young partners have experienced, as children, the cost of static balances. They are terrified of the possibility of repeating in their own marriage the dysfunctional motifs of their parents’ relationship. Amidst the cloud of changes and inversions that blur the picture, the anguish increases the need for vigilance. Men and women search, worry and bleed, but gradually realise that there are no easy solutions and that in any case these will not come from the outside.
For all the wobbles of recent decades, the extended family remains our perennial shelter. But even this stable point of reference has changed in form. At the beginning of the new century, the contemporary multifaceted, colourful and complicated mixed families of the postmodern era all jostle for space in the castle of the extended family,.
The extended family of the separated couple includes the new families that the two ex-partners are going to create. Their children and grandchildren will become relatives with the children and grandchildren of the relatives of their new partners. The children that originated from the broken marriage will have other siblings and they will live together with children from other marriages. These children will share and exchange their parents with their stepfathers and stepmothers who will raise and share the love and care for their own children with other children whom they did not know before they suddenly entered their lives.
Indivisibility of Mind and Body
Let us now focus on another crucial issue with enormous implications for mental health professionals; the gradual recognition of the undivided unity of mind and body, not only by the scientific community but also by the public. The connection of health with mental health on a theoretical as well as clinical level is a key quest these days.
The outlook for the future is that professionals of our field will be playing a central role in health. A great deal of doctor visits are made by people who have no organic disease but suffer from what is called somatised stress. While the fragmentation of medicine continues to dominate (we have specialties for every part of our body and for all bodily functions separately), there are now clear indications that our perceptions, our cognitive constructions and the accompanying emotions have a significant impact on physical health.
Therefore, instead of trying to pinpoint “objective” stressful factors that are supposed to apply to all human beings we should develop concepts and principles which allow the understanding of the perceptions, emotional reactions and behaviours of specific individuals and social groups that lead to negative and inauspicious interpretations, choices and perspectives. From this viewpoint, one could claim that therapists’ and counsellors’ interventions critically contribute to the prevention and treatment of organic symptoms.
Over the last decades, the competitive, conflicting concepts and dualist categories deeply embedded in the foundations of western civilization recede in favour of synthetic, non-disjunctive concepts such as brain and intellect, nature and man, thought and emotion. The contemporary, holistic approaches and applications in the field of health and the generalised use of the term “psychosomatic” are based on the recognition of the interdependence between mind and body in all phases and aspects of health and illness. Today, an increasing number of researchers and clinicians understand that, ultimately, all health disorders are psychosomatic.
Large international organisations have detected these general trends. They gather evidence and study the future health structures that will be based on innovative, composite healthcare models. According to the new standards, sufferers would seek help from services staffed with specialists in both mental and physical health. Diagnoses and decisions about further interventions will be made jointly by specialists from different areas of expertise, the sufferer and their family.
The Complexity of the Field of Mental Health
Even a superficial glance at the field of Health and Mental Health will show that we are flooded in theories, research data, methods and techniques for diagnosis and treatment. There are over one hundred different branches in Psychology, the psychotherapeutic approaches proliferate at a dramatic pace and the specialisations are countless.
In a world of increasing complexity, the scientific thinking and practice continues to be based on static and linear specifications. Although we increasingly realise that everything is interrelated and nothing remains unchanging, and while the hitherto impenetrable boundaries between cognitive fields such as psychoimmunebiology, neuropsychology and psychoneuroimmunebiology— are quickly bridged over, health and mental health are still defined on the basis of separate models. We continue to try to pinpoint isolated causes for the visible organic and psychosocial symptoms of dysfunction in individuals, families and wider social groups, and as a result we are led to the arbitrary fragmentation of the phenomena and we arrive either at overgeneralizations or at the Babel of specialised dialects of the different scientific disciplines and theoretical models. But if we do not keep abreast of developments and remain in tune with the pace of our time, we will not be able to listen to the true aspects of the demands and problems we are called upon to respond to.
Now that everything moves extremely fast, people demand immediate advice for the problems that put pressure on them at that time. The requests focus on visible, clear problems, but the complicated processes that lie at the base of the iceberg are ignored. Pharmaceutical companies make millions out of the public’s need for fast and easy solutions to the various problems of our era. Parents, stressed and terrified of the minefields that their children are treading on every day, are looking for ways to control their behaviour. They resort to prohibitions, bribes and benefits in order to protect them. But since this kind of underhand approaches usually reinforces instead of eliminating the visible frictions, reactions and violations, bitterness and frustration escalate.
Yet while the requests for the resolution of different demands multiply, one can discern also an increasing preoccupation with existential problems. More and more people seek answers to questions of who I am, where I am going and why. Psychotherapy is elevated to a central social mechanism, as it provides the fertile ground on which to change ourselves and our relationship with our environment. But apart from the fact that psychotherapy absorbs some of the rumblings that threaten the social constructs’ stability, it suggests and processes more secure and creative ways of approaching and making the most of the opportunities and the choices that the new wonderful world we created offers, without losing our traces, our nature and our identifications.
Without a composite viewpoint,we miss the criteria for making choices and decisions, and run the risk of disorientation and decreased efficiency. Moreover, the Babel of specialised scientific disciplines and different theoretical models complicates the necessary collaboration between experts that are called upon to face together interrelated data, situations and experiences.
The Holistic Perspective
Under the circumstances that have been created in contemporary societies, we as therapists and counsellors of all kinds need a broad and flexible context within which to integrate and compound our knowledge and experience. In order not to misinterpret the visible phenomena we observe in one part of the picture, it is essential that we broaden our field of view. In so doing, we will be able to observe the interactions within which we participate and follow the evolutionary processes.
The holistic viewpoint of life and knowledge that systemic epistemology offers us is an invaluable tool for understanding and managing the diversity and complexity of life and knowledge that characterise our era. It is as if we have implanted in our minds a wide-angle lens that allows us to see the whole picture. Through this kind of perspective, we are led from the isolated phenomena, symptoms, etc. to a panoramic picture of the system.
The systemic viewpoint has revised the person-centred approach of traditional scientific thinking. When the field of observation and action is expanded, the crucial interactions and mechanisms that led to visible symptoms and dysfunctions can be detected; for all severe health and mental health problems —mental disorders, family problems, organic diseases, chemical substance dependencies— are the obvious symptoms behind which complex combinations of biological, psychological and social factors are hidden.
According to this connective point of view, individuals, families and all broader social groups are defined as biopsychosocial systems. That is, living systems’ psychosocial and biological structures and processes are indeed separate but interlinked. Nevertheless, their inner order is hierarchical. In other words, the psychosocial processes that belong to a higher hierarchical level determine to a great extent the biological and physical–chemical processes of the whole biopsychosocial system. This lengthy, complex word implies that all the phenomena of health and illness, mental and physical, are united and collective. Hence, every phenomenon should be studied within the scope of a holistic theoretical context.
Another highly useful admission of the systemic viewpoint is that under the surface, under the visible phenomena, very powerful invisible vibrations take place and overturn the visible balances when the time comes. In other words, under the obvious chaos there is another order of things that, when the time comes, will manifest itself in the form of new structures and a new cycle of processes on higher organisational levels.
In the field of mental health the systemic approach has decisively contributed to the revision of established beliefs about how mental, physical or social disorder is created, preserved and treated. Leveraging the already accumulated knowledge in a synthetic manner, we are led to approaches and applications that increase the effectiveness of our interventions. Systemic thinking does not offer solutions, but opens new paths and prospects. It teaches us to observe ourselves and our environment, it teaches us to ask, connect, organise and compound pieces of information. By participating in what is happening inside of us and around us, it teaches us to trust other people, to collaborate on a give-and-take basis.
In an era when various changes occur at all levels, the issue is to comprehend and manage the continuously varying, unstable and uncertain conditions, the successive inversions in thoughts, emotions and behaviour. Through our therapeutic role, we are called upon to help our clients achieve the painful transition from stories of stability to stories of endless change on every level. Therefore, placing our work with individuals and families in the context of macroscopic changes constitutes a crucial dimension of our therapeutic role today. Disregarding the changes at the wider cultural level is to the detriment of our effectiveness. Having realised that the therapists’ observations and interventions are not objective truths that apply to all conditions, the only safety net if we are not to lose contact with the others’ reality is to create communication bridges with the individuals and families that turn to us for help, as well as the professionals we work with.
Ultimately, the self of the mental health professional is the basic tool for his work, since his observations and evaluations are filtered through his perceptions, emotions and images that already exist within him. His personal experiences create the context of reference within which he organises the stimuli he receives. My personal and educational experience has convinced me that the only way to organise the information is the emotional participation in everything that is happening. Through his own therapeutic course, the future therapist experientially comprehends the laborious therapeutic process. This in vivo learning experience leads to a deeper understanding of the family dynamics, as well as the interactive family motives. During this personal course in a direct and deeply experiential way, the future therapist kneads the personal along with the theoretical and practical knowledge that he gathers during his specialisation and continues to accumulate through his role as therapist. This whole process contributes substantially to the creation of a compound personal and professional identity, offering direction as well as meaning to the future therapist.
When the impenetrable boundaries, the dichotomies, the arbitrary fragmentations and the ‘or’ disjunctions collapse, the path is paved for seeking research, therapeutic and educational approaches, methods and techniques for managing the complicated problems we have to deal with as mental health professionals.
Only when the disjunctive logic and the blinkers that impede the holistic perception of life and knowledge have disappeared will we be in a position to organise the pieces of information about the systems we intervene to, to clarify our role and make the most of the various approaches, methods and techniques that are suitable for certain conditions. Then the specialisations, the theoretical and practical choices, will not be considered as competitive approaches but rather as alternative interventions that will enrich our repertoire and increase our effectiveness. The practical implementation of a composite theoretical approach could resolve many of the artificial dichotomies and dilemmas that occurin the daily clinical practice, so as all questions and dilemmas could be answered with a “depends on” or with an “and”.