Peter F. SchmidPeter F. Schmid

ACKNOWLEDGEMENT OR ACKNOWLEDGEMENT OR KNOWLEDGE?KNOWLEDGE?

A person-centred approach to A person-centred approach to psychopathology and diagnosispsychopathology and diagnosis

Metanoia, London, April 9, 2006Metanoia, London, April 9, 2006

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I. Personal anthropology:I. Personal anthropology:Authenticity and alienationAuthenticity and alienation Health?Health? Dis-order?Dis-order? Healing?Healing?

II. Phenomelogical epistemology: II. Phenomelogical epistemology: Acknowledgment and knowledgeAcknowledgment and knowledge Not-knowing?Not-knowing? Conceptions?Conceptions? Disorder-specific knowledge? Disorder-specific knowledge? Diagnosis?Diagnosis?

III. CriteriaIII. Criteria for a genuine person-for a genuine person- centred conceptualization centred conceptualization

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„„Don’t ask the doctor,Don’t ask the doctor,ask the patient“ask the patient“Jewish proverb

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I. Personal anthropology: I. Personal anthropology: AuthenticityAuthenticity

What is „psychological health“?What is „psychological health“?

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I. Personal anthropology:I. Personal anthropology: AuthenticityAuthenticity

Rogers’ personality theory includes social criticism.

We are not only in relationships; as persons we are relationships.

A person is independence and interrelatedness (substantial & relational).

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PERSON

© Peter F. Schmid

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I. Personal anthropology:I. Personal anthropology: AuthenticityAuthenticity

Rogers’ personality theory includes social criticism.

We are not only in relationships; as persons we are relationships.

A person is independence and interrelatedness (substantial & relational).

A person-centred consideration on what a “healthy” or “fully function” person is, must include a theory of social criticism.

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I. Personal anthropology:I. Personal anthropology: AuthenticityAuthenticity

To be a person meansto live the process of authenticity..

To live authentically means to be able to always gain anew the balance between one’s uniqueness and living together with the others and the world.

In the “fully functioning person” self-realization and solidarity coincide.

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““This above all: to thine own self be true, This above all: to thine own self be true, And it must follow as the night the day,And it must follow as the night the day,

Thou canst not then be false to any man.Thou canst not then be false to any man.““Shakespeare, Hamlet

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““You shall love your neighborYou shall love your neighboras yourself."as yourself."

Lev 19:18; Mt 22:39

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I. Personal anthropology:I. Personal anthropology: AuthenticityAuthenticity

Authenticity is the process of becoming the author of one’s own life.

in order – dis-order

firm – in-firmity

ease – dis-ease

?“health / heal”: * “whole”

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I. Personal anthropology: I. Personal anthropology: AuthenticityAuthenticity

To be a person meansto live the process of authenticity.

Person-centred is process-centred.

The process is the contents is the meaning.

Person-centred personality & society theory starts from a process theory of authenticity, not from a theory of disorders.

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I. Personal anthropology: I. Personal anthropology: AlienationAlienation

What is „inauthentic“?

What does psychological suffering mean?

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I. Personal anthropology:I. Personal anthropology: AlienationAlienation

A person becomes inauthentic, if he or she is alienated from him- or herself and the others..

Psychological suffering is the result of a Psychological suffering is the result of a fundamental “self-contradictoriness”.fundamental “self-contradictoriness”.

The “maladjusted person” lacks self-The “maladjusted person” lacks self-confidence confidence (sovereignty deficit)(sovereignty deficit) andand trust in the others and the world trust in the others and the world (relationship deficit)(relationship deficit)..

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I. Personal anthropology:I. Personal anthropology: AlienationAlienation

Suffering due to alienation is a signal of a deficiency or a loss of authenticity.

A psychological symptom is a cry for help.

Symptoms are as manifold as persons and situations are manifold.

The therapeutic answer is not uniform but unique.

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I. Personal anthropology: I. Personal anthropology: AlienationAlienation

Inauthentic persons are alienated from themselves and their others.

Suffering persons communicate to themselves and to others by symptoms that they need help, because their process of striving towards authenticity failed or got stuck.

Process-specific is not symptom-specific.

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I. Personal anthropology:I. Personal anthropology: TherapyTherapy

What is the response?

What “helps”?

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I. Personal anthropology:I. Personal anthropology: TherapyTherapy

Therapy is the facilitation of personalization as a process of becoming independent and of co-creating relationships.

Therapy is personality development through encounter.

Despite of symptom specifity the therapeutic answer is always a certain kind of relationship: encounter.: encounter.

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I. Personal anthropology: I. Personal anthropology: TherapyTherapy

Person-specific is not symptom-specific and not disorder-specific, but uniquely process-specific.

Disorder-oriented or goal-oriented is not person-oriented or process-oriented.

The relationship is always the same and it is always different: the therapist is different, if the client is different.

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I. Personal anthropology:I. Personal anthropology:Authenticity and alienationAuthenticity and alienation Health? Dis-order? Healing?

II. Phenomelogical epistemology: II. Phenomelogical epistemology: Acknowledgment and knowledgeAcknowledgment and knowledge Not-knowing?Not-knowing? Conceptions?Conceptions? Disorder-specific knowledge? Disorder-specific knowledge? Diagnosis?Diagnosis?

III. CriteriaIII. Criteria for a genuine person-for a genuine person- centred conceptualization centred conceptualization

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„Each experience, which deserves this name, thwarts an expectation.”

Hans–Georg Gadamer

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II. Phenomelogical epistemology:II. Phenomelogical epistemology: AcknowledgmentAcknowledgment

The epistemological paradigm change of PCT:In encountering the Other I do not think what I could know about him or her, rather I am ready to accept what he or she is going to disclose.

Acknowledge refers to psychotherapy as the art of not-knowing.

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ENCOUNTERThe relationship person to person

© Peter F. Schmid

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II. Phenomelogical epistemology:II. Phenomelogical epistemology: AcknowledgmentAcknowledgment

The epistemological paradigm change of PCT:In encountering the Other I do not think what I could know about him or her, rather I am ready to accept what he or she is going to disclose.

Acknowledge refers to psychotherapy as the art of not-knowing.

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II. Phenomelogical epistemology:II. Phenomelogical epistemology:ReflectionReflection

Personal encounter needs reflection.

Immediate presence is followed by co-reflection.

The initial encounter transcends into a personal encounter relationship.

While in the “encounter mode” categorization is impossible …

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“… “… the existential encounter is important. the existential encounter is important.

… … in the immediate moment of the therapeutic in the immediate moment of the therapeutic relationship, consciousness of theory has no relationship, consciousness of theory has no

helpful place.helpful place.

… … we become spectators, not players – we become spectators, not players – and it is as players that we are effective.and it is as players that we are effective.

… … at some other time we may find it rewarding to at some other time we may find it rewarding to develop theories. In the moment of relationship, develop theories. In the moment of relationship,

such theory is irrelevant or detrimental.such theory is irrelevant or detrimental.

… … theory should be tentatively, lightly, flexibly,theory should be tentatively, lightly, flexibly,in a way which is freely open to change, and should in a way which is freely open to change, and should

be laid aside in the moment of encounter itself.”be laid aside in the moment of encounter itself.”Carl Rogers, 1962

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II. Phenomelogical epistemology:II. Phenomelogical epistemology:ReflectionReflection

While in the “encounter mode” categorization is impossible …,

… in the “reflection mode” we cannot but use concepts and categories.

We cannot not think,

we cannot not categorize.

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II. Phenomelogical epistemology:II. Phenomelogical epistemology:ConceptionsConceptions

Conceptions are always our own constructs.

We decide what we perceive out of a pre-understanding.

Conceptions must become explicit in order to enable their falsification.

Responsibility requires to reflect the conceptions.

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II. Phenomelogical epistemology:II. Phenomelogical epistemology:KnowledgeKnowledge

Existential knowledge is the basis for our Existential knowledge is the basis for our decisions to act.decisions to act.

Knowledge means to be in-formKnowledge means to be in-form-ed.

Knowledge must be experience-based.Knowledge must be experience-based.

Knowledge must be relationship-based.Knowledge must be relationship-based.

Knowledge serves acknowledment.Knowledge serves acknowledment.

Comprehension always is knowledge-based; Comprehension always is knowledge-based; knowledge in-forms empathy.knowledge in-forms empathy.

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II. Phenomelogical epistemologyII. Phenomelogical epistemology Acknowledgment and knowledge Acknowledgment and knowledge

The task is to personally and professionally handle the dichotomy of not-knowing and knowing, acknowledgment and knowledge.

A personal use of conceptions and theories does not hinder experience but foster it.

Therefore it is crucial to decide which theories we use.

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II. Phenomelogical epistemology:II. Phenomelogical epistemology:Disorder-specific?Disorder-specific?

““It is with some ‘fear and trembling’ It is with some ‘fear and trembling’ that I advance the concept that I advance the concept

that the essential conditions of psychotherapy that the essential conditions of psychotherapy exist in a single configuration -exist in a single configuration -

even though the client may use them even though the client may use them very differentlyvery differently.”.”

Carl Rogers, 1957

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II. Phenomelogical epistemology:II. Phenomelogical epistemology:Disorder-specific?Disorder-specific?

Process-differentiation? Process-differentiation? Yes.

Process-specificity? Process-specificity? Yes.

Disorder-Disorder-centeredcentered concepts? concepts? No.

Which knowledge should we use?Which knowledge should we use?

We do not yet have a genuinely person-We do not yet have a genuinely person-centred systematics.centred systematics.

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II. Phenomelogical epistemology:II. Phenomelogical epistemology:Diagnosis?Diagnosis?

“It is not stated that it is necessarythat the therapist has an accurate psychological

diagnosis of the client.Here too it troubles me to hold a viewpoint so at

variance with my clinical colleagues.The more I have observed therapists, and the

more closely I have studied research, the more I am forced to the conclusion that such diagnostic

knowledge is not essential to psychotherapy.”Carl Rogers, 1957

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II. Phenomelogical epistemology:II. Phenomelogical epistemology:Diagnosis?Diagnosis?

„„In a very meaningful and accurate sense, In a very meaningful and accurate sense, therapy is diagnosis,therapy is diagnosis,and this diagnosis isand this diagnosis is

a process which goes ona process which goes onin the experience of the clientin the experience of the client, ,

rather than in the intellect of the clinician.”rather than in the intellect of the clinician.”Carl Rogers, 1951

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II. Phenomelogical epistemology:II. Phenomelogical epistemology:Diagnosis?Diagnosis?

Psychological diagnosis can only be a Psychological diagnosis can only be a phenomenological process diagnosis, phenomenological process diagnosis, not a diagnosis in terms of not a diagnosis in terms of symptomatology or etiologysymptomatology or etiology..

It is a co-diagnostic processIt is a co-diagnostic process by experiencing by experiencing and reflectingand reflecting which development the which development the client needs in the process of client needs in the process of personalizationpersonalization..

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II. Phenomelogical epistemology:II. Phenomelogical epistemology:Specific training?Specific training?

The process of becoming a therapist is The process of becoming a therapist is personality development through personality development through encounter (as is therapy), encounter (as is therapy),

it is not the accumulation of skills, tools, it is not the accumulation of skills, tools, rules and techniques.rules and techniques.

Process-specific training?Process-specific training? Yes.

Problem-centred training? Problem-centred training? No.

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II. Phenomenological epistemology:II. Phenomenological epistemology: Process-specificity Process-specificity

Does person-centred “disorder”-specific knowledge exist? Yes.

Does a person-centred systematic description of inauthentic processes exist? Scarcely.

Does a genuinely person-centred systematics of process-specificity exist? No.

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I. Personal anthropology:I. Personal anthropology:Authenticity and alienationAuthenticity and alienation Health? Dis-order? Healing?

II. Phenomelogical epistemology: II. Phenomelogical epistemology: Acknowledgment and knowledgeAcknowledgment and knowledge Not-knowing? Concepts? Disorder-specific knowledge? Diagnosis?

III. CriteriaIII. Criteria for a genuine person-for a genuine person- centred conceptualization centred conceptualization

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III. CriteriaIII. Criteriafor a genuine person-centred for a genuine person-centred

conceptualization of different processesconceptualization of different processesof personality developmentof personality development

1.1. on the basis of personal anthropologyon the basis of personal anthropology

2.2. phenomenological & close to experiencephenomenological & close to experience

3.3. falsification must be possiblefalsification must be possible

4.4. hermeneutichermeneutic

5.5. existentialexistential

6.6. including social criticismincluding social criticism

7.7. triggering genuine humanistic researchtriggering genuine humanistic research

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Back to the clientsBack to the clients ... ...

... to the ... to the challenge to open up and to risk challenge to open up and to risk the co-creation of becoming a unique the co-creation of becoming a unique relationshiprelationship and and to co-reflect it to co-reflect it

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Back to the clientsBack to the clients ... ...

… … to further develop the unique stance of to further develop the unique stance of person-centredness, its image of the person-centredness, its image of the human being and its ethicshuman being and its ethics

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Back to the clientsBack to the clients ... ...

… … to face the challenge to face the challenge to create an to create an understanding of ourselves beyond the understanding of ourselves beyond the categories of order and disordercategories of order and disorder

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ACKNOWLEDGEMENT ACKNOWLEDGEMENT ANDAND

KNOWLEDGEKNOWLEDGE

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„„Don’t ask the doctor,Don’t ask the doctor,

ask the patient!“ask the patient!“

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