Créditable ou Discréditée?

Abstract

The questionnaire on continuing education by the Canadian Psychiatric Association's Council on Education and Professional Liaison, sent in 1978 to all Canadian psychiatrists, raises in the author's mind, in spite of his participation in its establishment, the question of the philosophy behind it. Indeed, seeing signs of a greater problem, he identifies the need for two studies, one dealing with the “object”, the other with the “relationship”. Not elaborating on the first one (description of patients and techniques) which is well known, he describes the second as the knowledge and significance of the encounter (that of two persons inevitably and structurally linked). This “area of relations” paradoxically given too little value in the teaching of psychiatry, is more analogical than logical, more intuitive than deductive, more perceptual than intellectual, and more multifactorial than linear. Yet, this dimension of the encounter (whether individual, familial, group or co-therapy) should take place in conjunction with the objective approach, but the latter occurs alone too often. In order to give to this field of relationship a scientific status of its own, and to reintroduce the techniques instead of using them as guard-rails, proper techniques or methods should be employed or developed if necessary. This includes on the one hand the learning of different levels of awareness and the widening of our perceptual, sensorial, intuitive and analogical capacities. (This would allow for an experience of the fundamental relationship between fields that are apart symptom-wise: dream and awakening, physical and psychic, interior and exterior, fantasy and reality, representations and objects, and so on.) On the other hand this leads us to increase our capacity to listen, to abandon ourselves and to get involved, and to “conceive” a presence within the relationship. Finally, there is this learning of how to observe oneself in a situation, of how to look at what is going on within the encounter (and it is in that very position and this very questioning that the concept of neutrality can be understood, not in the legendary phlegm of impenetrability). This can be done within an “experiential” teaching: for the therapist this means the experience and the study of his own involvement, either with a patient or in groups. Another method is supervision, not as “super”-vision but rather as “inter-discovery” and not as control but rather as “ex-pression.” Working in small groups with colleagues where one can enquire about others’ experiences without any normative goal and with an open attitude is desirable. Another tool would be professional meetings, but not in their current form which is not adapted to the field of the relationship. And so on. The author sees a fundamental necessity for these two fields of the “object” and the “relationship” to be taught conjointly, and neither one nor the other to be excluded from the psychiatrist's training; which is not the case at present. The “field of the object” implies an effort at objectifying, defining variables, causes, using experimental methodology, and a more quantitative analysis. The “field of the relationship” implies positions that are often opposed to this. This contradiction seems necessary and inevitable within every person. One tendency is to make ourselves believe that we avoid this contradiction by pretending to total objectivity: that of scientific psychiatry and clear logic. Finally the author returns to the questionnaire that, precisely in its form, is too uniquely meant for an objective teaching: teaching of diagnoses, illnesses, chart controls, patient controls, teaching through questionnaires, case presentations, putting emphasis on articles or textbooks. This proposed method is adapted for teaching persons considered as entities; and learning techniques considered as reified tools. This is exactly the classical stream of university courses and specialty examinations. This reinforces the illusion. There is also the danger, via the “credit” game, that it will strengthen the already strong tendency to mere objectifying of the subject, of the therapist and of science; that it will privilege a normative vision; and discredit certain essential and humanistic dimensions.

Un enseignement du savoir-être en psychothérapie

“…Mais nous pensons qu'on devrait plutôt les dégager de l'apprentissage de capacités que nous nommons intersubjectives pour se pencher plutôt sur l'utilisation de ces dernières auprès des patients. Nous avons déjà expliqué ailleurs (Crombez, 1980) comment ces découvertes peuvent être faites en dehors des démarches classiques que sont la thérapie personnelle et la supervision ; elles préparent le terrain à ces démarches et permettent de ré-introduire au sein des institutions un souci et un enseignement de l'ordre du subjectif.…”