<\/p>\n
By
\nRobert DePaolo<\/p>\n
Abstract<\/p>\n
This article discusses
\nclinical practice in terms of the medical model, particularly with regard to
\nthe Freudian notion of a psychic homeostat, and more broadly, the tendency in
\nphysiological and psychological systems to re-integrate in response to systemic
\ndisruptions. The point is made that the personality automatically moves toward
\nre-stabilization and state restoration when under duress and that clinical
\nintervention can either enhance or interfere with that process; thus raising
\nthe question of whether counseling is appropriate, whether the ostensible
\npathology can be culturally, \u00a0as opposed
\nto existentially defined, and how clinicians might proceed to establish a new
\nstasis that coincides most closely with the client\u2019s natural restorative
\nresponses and cognitions.<\/p>\n
With respect to the process of psychotherapy there is nothing unusual or derelict about \u201cleaving
\nthe client to his own devices\u201d – even in the aftermath of duress (Aubrey, Bond et. al. 1997). Since \u00a0Sigmund and Anna
\nFreud (1967) first developed a framework for the use of defense mechanisms (which Sigmund likened to the immune reactions to disease in the soma)
\nclinicians have come to agree that defense mechanisms work to restore stability. In that sense they operate much the same way as any system in nature
\n\u2013 seeking, as it were, to revert to a prior state. All such systems, which could encompass everything from physiology to cognition to atoms to the
\nstructure of human language require some degree of redundancy. Indeed one could draw a parallel between quantum mechanics and clinical psychology by suggesting
\nthat, like the photon, the personality has a memory of its inherent structure and is disinclined to deviate from that.<\/p>\n
<\/p>\n
The traditional, psychoanalytic view derives from a medical model and holds that the true essence of pathology is not to be found in the original contaminant \u2013 be it microbe
\nor traumatic event \u2013 but rather in the individual\u2019s response to that event. (Shah, Mountain 2007). In somatic terms, an elevated body temperature is needed to mobilize phagocytes.<\/p>\n
Yet if this leads to chronic high fever the ostensibly curative immune response would in itself be viewed as the symptom of disease,
\ni.e. the homestatic correction would be too extreme. Similarly, psychological defense mechanisms are needed to restore psycho-stasis but if mobilized to a harmfully
\ndistorted degree they would themselves come to be viewed as part of the syndrome.<\/p>\n
The preceding statements amount to little more than a collective tautology in that they simply reiterate common themes of clinical practice. After all, cognitive-behavior
\ntherapists, psychoanalysts and client-centered counselors all pivot off the idea that the secondary disease process \u2013 the client\u2019s maladaptive schemes,
\nattitudes and self image – must, like an elevated body temperature, be modulated before the original contaminant can be dealt with. So in counseling
\nthe language and cognitions of the client are altered in the direction of reasonableness and functionality, regardless of the method.<\/p>\n
On the other hand such a simple premise has two potentially broad and interesting ramifications with respect to diagnosis and treatment. One has to do with the question of whether and to what extent treatment is needed. The other pertains to whether counseling could actually be counterproductive (Baker, 1996), (Whittaker, 2004).<\/p>\n
Reverting back to the somatic model: an elevated body temperature could become extreme in response to two factors: the degree of infection (homeostatic disruption) and the duration
\nof infection. If the instability produced by the event is mild to moderate, the adaptive response will not likely be extreme or lengthy, in which case the \u201ctake
\nan aspirin and call me in the morning\u201d adage would constitute a best practices standard. By the same token, treatment beyond that (for example prescribing
\nstrong antibiotics) would run askew of the ethical mandate against over-treating patients.<\/p>\n
In terms of\u00a0clinical practice it would mean that following an intake the counselor might in some instances explain to the client that the problem is not severe, that using his
\nown natural coping devices (defense mechanisms and arousal modulating behaviors) would be sufficient. In order to make that determination the counselor would
\nfirst have to decide on the severity and duration of the disruptive event or events, on the client\u2019s defensive skills and perhaps most importantly, on the
\nclient\u2019s resilience (Shiskina, Kalinina.et. al. (2010)<\/p>\n
The Susceptibility Factor<\/em><\/p>\n Just as a minor infection can lead to severe illness in a patient with a pre-existing immune disorder, so too could a minor psychological setback lead to more severe psychopathology for \u2022 A tentative self image, whereby the client has no clear identity parameters and consequently cannot protectively categorize his emotions, behaviors or the effect events have on \u2022 A constitutional predisposition \u2013 high incidence of pathology in the family and a history of susceptibility to duress.<\/p>\n \u2022 A chronically high arousal level, as seen in PTSD clients and those with a proneness to panic attacks and medical problems such as hypertension.<\/p>\n \u2022 The presence of neurological disorders that limit the client\u2019s capacity to attend and by virtue of perseveratory tendencies preclude his being able to integrate experience.<\/p>\n \u2022 Physical problems, forcing the mind-body system to devote more energy resources to physical adaptations, thereby depleting energy resource that might otherwise be used to \u2022 Inadequate language capacities, rendering defense mechanisms (which rely on labeling and proportional thinking\/self-persuasion capacities) ineffective at fending off
\nan individual with low resistance to stress. While determining pathology-resistance is a somewhat subjective process, certain factors could provide grist for the mill, for example..<\/p>\n
\nhim. Bear in mind that this is different from a poor self image<\/em> which, despite its drawbacks can often provide enough clarity to fend off duress \u2013 for example by enabling the individual to revert to a passive, dependent mode, thereby freeing himself from the burden of conflict resolution and allowing him to egosyntonically have his needs to be met by others.<\/p>\n
\nenhance psychological adaptation.<\/p>\n
\nduress and instability.<\/p>\n