Psychopathology and Alternative Therapeutic Approaches: Psychosis and the Possibilities Offered by the Therapeutic Approach of Family Constellation
"What the father is silent comes out in the mouth of the son, and I have often found that the son was the father's revealed secret."
Friedrich Nietzsche
“What is silent in the first generation, the second generation carries in the body.” Françoise Dolto
The questions that guided this reflection were: Would it be possible to work with psychotic conditions based on Family Constellations? What are the possibilities and consequences of an alternative therapeutic approach to act on conditions as complex and delicate as that of psychoses? Could we use this technique as an alternative for conflict resolution, mainly because we are talking about conflicts that go beyond generations and involve the family, ancestral system as a whole?
This author's interest in working therapeutically with psychoses began in 1998, when the first contact with psychotic clients was made in private and public psychiatric institutions. It began by working with inpatient psychiatric patients. The clientele presented intense psychic suffering and the treatments were long and marked by several relapses. The teams responsible for the treatments were multidisciplinary, involving psychiatry, psychology, occupational therapy, nursing, physical education, therapeutic companions, family therapists, music therapists, art therapists, among others.
Inside the psychiatric hospital, in addition to learning from the clientele the clinical listening of suffering and dealing with the extreme situations present in this environment, I was able to verify the necessary steps for rehabilitation and social reintegration offered by therapeutic monitoring and family therapy centers. Psychiatry and nursing were essential for emergency containment, support, relief, treatment and psychopharmacological follow-up. Psychology and occupational therapy worked with therapeutic groups to manifest and elaborate themes and difficulties presented by patients in their sociocultural environment. As the patient improved in his general condition, reintegration into his social and family environment was worked on. Often, at this moment, we noticed a worsening of the staff and resistance from the family structure. Individual psychotherapy, family therapy sessions and therapeutic follow-up came into play. Many patients pointed out that the improvement obtained in the so-called “safe environment” of the institution, of the therapeutic groups and of the individual attendances was put to the test when they returned to their homes, to the social and family life . They realized they were regressing and often expressed sadness and hopelessness: “there's no way, I'm going to be stuck in here forever” (sic).
In clinical team meetings and family therapy study centers, we addressed this theme a lot. How delicate it was for the patient to return to his daily, professional, social and family life. In this, there were triggers that restarted a cycle of stress, anguish, impulsivity, violence, self and/or heteroaggressiveness , sadness, pain and suffering. It was not enough to work the patient individually. It was also necessary to work on their family system. It was necessary to work on how he dealt with the stimuli and challenges of the sociocultural environment.
Patients with histories of several hospitalizations or who had been followed up for decades in day hospital treatments, CAPS, were frequent in the institution and in the mental health environment itself. Chronic patients, with repetitive, recurrent and insistent suffering. Of course, the suffering was also visible in families, both nuclear and origin.
In clinical discussions, we sometimes discussed the intrafamilial phenomenon of the scapegoat. That is, the one the family "chosen" to carry a slightly larger share of the family's burdens, secrets, shadows. The guilt, the pain, the suffering, the traumas, the secrets of a family system, manifested in a specific member. A partly unconscious phenomenon that often caused distancing, divisions, separations, exclusions in the family environment.
A visible improvement was noticed when the family participated in therapeutic procedures and processes of reintegration and social rehabilitation. Patients showed better adherence to treatment and crises and outbreaks decreased, giving way to new ways of acting in the professional environment, in society, in the family, in relationships in general.
"The author's clinical posture as a professional has always been psychoanalytic, acting from the Freudian and Lacanian references. In 2006, in one of the supervisory meetings of the family therapy department, which followed the systemic framework, a colleague mentions a German professional who was bringing a new way of looking at, working with psychoses, using a systemic phenomenological approach that he called Family Constellations. From the book "Simetria Oculta do Amor" by Bert Hellinger, little by little, contact was made with this theory, look, posture and alternative therapeutic approach"
From then on, contact was made with several trainers of the technique, in Brazil, Argentina and Europe and it was possible to verify how this approach brought other perspectives and possibilities for patients in psychological distress. Deepening familiar systemic theories helped discover new ways of looking at and dealing with psychiatric conditions. The possibility of resolving intra-family conflicts and starting healing processes in the family system became more palpable and evident.
This article intends to lead the reader to reflection and to look at this therapeutic approach that has been concerned with intra-family conflicts, bringing answers and possibilities to split systems, weakened and injured by diverse and repeated psychotic conditions that sacrifice and maintain a hidden mist over histories. long forgotten and even so, bitter and painful.
(Continues)
SCHUBERT, R. - Psychopathology
and Alternative Therapeutic Approaches: Psychosis and the Possibilities Offered
by the Therapeutic Approach of Family Constellation. Medical and Resarch
Publication, Volume 6, Issue 5, April 2023
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