Biomedical Engineering Reference
In-Depth Information
without the involvement of emotionality. The person is considered as a complex structure
of knowledge that is autonomous and shut from the organization point of view. The person
autonomously constructs his or her own meaning on the basis of his or her own experience
and these constructed meanings guide the person's future experiences. Therefore, these two
levels in which it is possible to operate a change are strictly interconnected. In the patient's
narrative it is difficult to discriminate the immediate experience from its explanation. Because
this one is a partial and self-referred explanation, it inclines to exclude what is not decodable
(Reda 1986; Cionini 1991). The first task of the therapist is to distinguish the immediate experi-
ence, the fact, from its explanation, the theory (Guidano 1987). In this way the therapist acts in
space, in the interface between these two dimensions (the fact and the theory), and offers to
the patient a new element, a new perspective able to upset the patient's structure. As we said,
this is easy for thoughts, but to start a true therapeutic change it is necessary that the patient
gets emotionally involved with the therapist. This implies that it is the significance of the rela-
tionship, its affective valence that guarantees the self-referential function according to which
the perceived discrepancy may be referred by the patient to himself or herself rather than to
the exterior. The emotional involvement is therefore the condition sine qua non to determine
a change. Meanwhile, a change also occurs in the therapist when he or she prepares himself
or herself to assume the “responsibility” to be there for the patient. According to Liotti (2001,
2005), the human being is motivated to recover by his or her own sufferings. The patient will
recover and therefore activates his or her motivational system of attachment to which the
activation of the attending system of the therapist has to match. Once the therapeutic alliance
is established, the internal motivational system of joint cooperation is activated thanks to the
explicit definition of the common goal. In this joint system there is a meaning sharing and
a reciprocal help request because the therapist can also and has to ask for the patient's help;
for example, he or she has to check that he or she has understood the patient. The therapist
therefore works to detect the organization of the personal meaning in the personal plan and
its functioning rules. Although this plan is often outside of the patient's consciousness, it
unconsciously guides the patient himself or herself. The new discoveries set up, by means of
self-reference, a process of restructuration and personal reorganization, able to “assimilate”
the pathological beliefs and the discrepancies appeared with the unbalance and to reveal the
innate motivations that are at the basis of the plan as a rule system regulating the personal
organization functioning. Each time that during the therapy a pathological belief is rebutted,
the process takes a step forward along the planned direction. At the time in which the thera-
peutic relationship is internalized, the therapeutic experience will sustain the continuity of
consciousness outside of the therapist office (Liotti 2005).
During the therapeutic course, the therapist has to abandon the role of external observer,
which holds absolute, objective, and right truths. He or she does not have the aim of indis-
criminately increasing awareness, because to awareness are connected the loss of spontane-
ity and immediacy and the emergence of unpleasant and disturbing emotions that stem out
from the difficulty of acknowledging oneself. Rather, the therapist aims to obtain an adap-
tive reorganization, a new homeostatic, wider, and more flexible equilibrium, by means of
the minimal modification of the patient's self-knowledge and of the minimal oscillation of
his or her identity sense. The goal is to let the patient experience and feel that his or her func-
tioning, personal meaning, and plan determine both his or her world and his or her freedom
while being in that world. Therefore according to Guidano, the therapeutic relationship
evolves in a supervision relationship, as if the patient were a naïf therapist which peri-
odically submit to a more expert colleague the trend of the cases he is healing, with the
unique difference that the case he is treating is himself. (1991, p. 184)
