STAGES OF PSYCHOTHERAPY
Psychotherapy can be defined as “A purposeful and willing relationship between at least two people, one who is supposed to know what he is doing, and the other who wants help to change his life for the better”.
The unfolding of the psychotherapeutic relationship is considered to proceed in four main stages: Early, Middle, Late and Termination. Each stage has its own tasks and sub-stages, and has to be reasonably completed before transition to the next can take place.
The correct order and development of each stage is essential if therapeutical progress is to be made, and it may be necessary at times to modify the overall strategy according to the stage of the relation.
1. EARLY STAGE
a) Perception of The Therapist
c) Technical Suitability
2. MIDDLE STAGE
a) Search for Patterns
b) New Information
3. LATE STAGE
4. TERMINATION STAGE
Each stage has its own characteristic tasks and difficulties, and requires different tactical interventions. The identification of each particular stage as psychotherapy proceeds, allows for a more effective therapeutic strategy.
1. The EARLY STAGE is the initial stage in which the patient and the therapist decide to devote much of their time, energy, and capacity to establish relations to the achievement of therapeutically targets. Sometimes the therapist finds himself strongly reluctant to enter this stage, and when this is the case he must choose not to treat the patient, or at least he must delay the treatment until he has identified and remedied the causes of his reluctance. The patient can commit himself immediately, unconsciously and automatically or he may require beforehand an exploratory period. The elements influencing the decision to be taken by the patient are:
· His perception of the therapist, or the extent to which he considers him to be competent.
· The intensity and quality of his motivation.
· The technical suitability or the extent to which the education, personality and past experiences of the patient fit the proposed therapeutically methodology.
Some patients can offer stiff resistance to certain techniques whereas they will accept others more readily, and due account must be taken of this when the initial therapeutic approach is drawn up. Sometimes it may be necessary to apply a tailor-made technique during the commitment stage, delaying the most effective and indicated methodology for later stages.
2. The MIDDLE STAGE is the most complex stage and constitutes the central body of the treatment. It can be divided into three concurrent aspects:
- the search for patterns,
- the, gathering of new information and the
The relative importance of each aspect varies according to the kind of problem and the type of patient but, in any case, in the initial stages of this step the sensation of psychic movement is more important than the nature of that movement. The Middle Stage must make the patient experience that he is becoming aware of something, and this is more important than what he is becoming aware of. Searching for patterns. Psychic phenomena and their behavioural manifestations do not occur just in any way, but rather they follow some more or less idiosyncratic rules and paths which we call patterns. Pathological patterns are characterized by their excessive rigidity, and by the fact that they are not in keeping with their present context, are unsuitably repetitive, and are harmful to the patient (De Rivera 1991).
The acquisition of new information is the part of the process which develops in the patient the cognitive and emotional structures necessary for correcting his mistakes, offsetting his defects and solving his conflicts.
3. The LATE STAGE follows the middle stage and represents its conclusion and success. There are three important aspects in this stage which need to be consolidated to ensure permanent therapeutic results. The first is the repudiation of the illness relinquishing all related elements, including pleasant ones such as the positive relation with the therapist, and useful ones such as the many ways in which responsibility can be shirked due to being ill. This process of repudiation or relinquishment is akin to grief, and the patient has to get over all his reasons for remaining ill and assure himself that, in spite of these reasons, he prefers his new healthy state of functioning. The other two aspects of the LATE stage are the initiation of free, appropriate and voluntary patterns of action, that replace old pathological behaviors, and the sustaining of these patterns through the creation of mental structures.
Frequently, this means the persistent adoption of mental hygiene habits and the permanent application of personal psychological techniques for preventive purposes.
4. The TERMINATION STAGE constitutes the “graduation” of the patient as an expert in the functioning of his own mind, and it implies that the therapist and the patient recognize each other as mature, autonomous, and independent individuals. This is the stage where positive transference relations, regressive forms of dependence, and childish idealizations have to be solved definitely. In this phase, the patient becomes aware of his own strength and realizes that he alone is responsible for his own life.
The three interventions of the therapist during this stage are:
1) the abdication of his role and the granting of his teachings and methods, which now belong to the patient,
2) the handing over of permission for the patient to develop his life and act on his own responsibility and
3) the definitive acknowledgement of the patient’s autonomy, and the affirmation of his own autonomy with respect to the patient. Although in some cases extremely fast, this stage often lasts longer than the rest of the treatment, either in the form of memories and fantasies concerning the therapist, particularly at times of stress, or as sporadic requests for isolated visits to the therapist.