​(Sobre o trabalho do Paul Wachtel)

 
O Paul Wachtel é uma grande referência no movimento integrativo em psicoterapia, que integra a abordagem psicodinâmica com a abordagem comportamental.
 
Já tivemos o privilégio de estar com ele algumas vezes e ele transmite sempre uma sensação de acolhimento que transparece também em sessão com os pacientes.
 
Uma das coisas que mais gostamos no Paul Wachtel é o extremo cuidado que ele tem no uso das palavras, preocupado em favorecer que os pacientes possam receber as suas intervenções de um modo transformador e não, pelo contrário, ativador das suas defesas.
 
O Paul Wachtel desenvolveu também o modelo Cyclical Psychodynamics, integrando a perspectiva mais psicanalítica da importância das experiências precoces, com a compreensão que as experiências são cumulativas e que o nosso desenvolvimento resulta de uma dinâmica entre os dois tipos de experiências.  A ideia é que cada pessoa tem um conjunto de interações na sua infância que determinam a forma como se relaciona consigo própria e com os outros, e que estes padrões de interação, por sua vez, favorecem que as pessoas que estão à sua volta se comportem com o próprio à semelhança das suas figuras de referência. Desta forma, a pessoa acaba por acumular uma série de experiências negativas, que vão reforçando os seus esquemas desadaptativos.
 
 Em termos terapêuticos, o Paul Wachtel propõe ajudar os pacientes a reconhecer estes padrões e o seu contributo neles, e estimula os terapeutas a adoptarem um estilo de comunicação que favoreça o reconhecimento desses padrões e a capacidade de os transformar em interações mais adapatativas.

Tenho estado a ler o livro “Succeding with Difficult Clientes: Applications of Cognitive Appraisal Therapy” de Richard Wessler, Sheenah Hankin e Jonathan Stern, e deparei-me com uma série de questões úteis de enquanto terapeutas nos colocarmos que me fez sentido partilhar convosco.

Deixo-vos o excerto:

“All therapists who practice CAT [Cognitive Appraisal Therapy] must understand their own personotypic affects [familiar emotional experiences that provide a sense of security] and emotional setpoints [nonconscious personal rules of living that prescribe how one should feel], especially as they influence interactions with difficult clients. Therapists should ask themselves the following questions to determine dominant personotypic affect and their own emotional setpoints:

1. What was the emotional climate of my family when I was growing up? What do I remember about my father’s and my mother’s predominant emotions?
2. What was the emotional “pitch” or intensity level in my household? Quiet, loud, highly emotional, or unemotional? Which feelings usually were expressed (and felt) loudly and which usually were expressed (and felt) quietly? How did my family maintain its typical emotional pitch or intensity level?
3. In what ways do I emotionally resemble my father? My mother? How did I learn to be like each of them?
4. What familiar feelings do I remember as a child growing up? What was my own emotional pitch or intensity level like?
5. Was there something that I routinely did not get from my mother and/or father that I wanted, and how did that typically make me feel? Was there something that I routinely did get from my mother and/or father that I did not want, and how did that typically make me feel?
6. What feelings do I seem to return to when I feel stressed? What is their typical level of intensity?
7. Conversely, what feelings do I seem to return to after I feel really good, and what is their typical level of intensity?

Once the therapist has a feel for his or her own personotypic affect and emotional setpoint, he or she should then identify typical justifying cognitions [beliefs produced to justify familiar emotional states] and security-seeking behaviors [actions that influence a person’s social environment so that its responses prompt personotypic affects, restore the emotional setpoint, confirm one’s personal rules, and thus evoke a sense of security], since they may well be played out in the therapy relationship by the therapist. Questions the therapist can ask of him/herself include:

1. What do I typically think of myself, of what I do, and who I am? What are my typical thoughts about my role in life?
2. What do I typically think of others and the world in general? What do I think of how others treat me and of how I treat them?
3. Is there something that I always want from others but do not get? Is there something that I always get from others but do not want? What is my role in this?
4. What do I think of hard work and responsibility? Do I honestly enjoy working hard, resent it, or vacillate between the two?
5. What is my characteristic way of relating to others? Am I usually the dominant or submissive one; the friendly or withdrawn or angry one; the active or passive one? Is this consistent in relationships, in friendships, at work? If not, how much does this vary and how?

Additionally, the therapist may find it helpful to identify how he or she was parented. This may give him or her insight into his or her personality style, as well as into how he or she might relate to the client. More specifically, does a client with a personality style similar to one’s parent(s) more strongly activate the therapist’s personotypic affect, justifying cognitions, and security-seeking behaviors? How does the therapist’s own personality style, molded in part by how he or she was parented, affect the client?
Finally, given all of the above, the therapist should ask him/herself the following additional questions:

1. What type of people in general do I find difficult or disagreeable, and why?
2. How do I typically react to and deal with such people? How do they react to me as a result?
3. How do I typically react to and deal with hostile–dominant people? How do they react to me as a result?

Once the therapist has answered these questions, then he or she is ready to work with difficult clients, to see these clients as not particularly difficult to work with, after all, and to do CAT without overpersonalizing what clients say and do, without being ruled by shame, self-pity, and anger, and without being judgmental or blaming toward who clients are and what they do in therapy.”