Failure and Transformation in the Relationship Between Patient and Therapist

Abstract

In the field of addictions, the changes believed to be effective by health professionals are usually those founded on programs based on the idea of control. However, control has its own limitations, and failures. Some failures in treating addiction appear to start a transformation of experience, be it personal or regarding the therapeutic relationship. A typical example of failure and transformation is how Alcoholics Anonymous works; this was originated by the spiritual direction that Swiss psychiatrist Carl Gustav Jung gave to one of his alcoholic patients. In extreme cases of the patient's death, professionals may experience absolute defeat and powerlessness. In any case, failure implies a deflation of the ego and the defeat of egocentrism.

Keywords :

• Apollonian medicine
• Dionysian medicine
• failure
• patient
• tame problems
• wicked problems ego
• professional
• control
• transformation
• Jung

Notes

4 The reader is referred to Rittel & Webber (1973) who suggested that problems can and should be usefully categorized into two types: “tame problems” and “wicked problems.” The former are solved in a traditional linear analytic known and tried “water fall paradigm”; gather data, analyze data, formulate solution, implement solution. The latter “wicked problems” can only be responded to individually, each time anew, with no ultimate, repeatable solution. Editor's note.

5 Treatment can be briefly and usefully defined as a unique, planned, goal directed, temporally structured change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual help-based (AA, NA, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which are not also used with nonsubstance users. Whether or not a treatment technique is indicated or contraindicated, and its selection underpinnings (theory-based, empirically based, “principle of faith”-based, tradition-based, etc.) continues to be a generic and key treatment issue. In the West, with the relatively new ideology of “harm reduction” and the even newer quality of life (QOL) treatment-driven model there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Treatment is implemented in a range of environments; ambulatory as well as within institutions which can include controlled environments. Treatment includes a spectrum of clinician–caregiver–patient relationships representing various forms of decision-making traditions/models; (1) the hierarchical model in which the clinician-treatment agent makes the decision(s) and the recipient is compliant and relatively passive, (2) shared decision making which facilitates the collaboration between clinician and patient(s) in which both are active, and (3) the “informed model” in which the patient makes the decision(s).

6 A figurative translation of this Latin formula is, it takes the Spirit of God to overcome the harmful spirit of alcohol.

7 It is useful to consider if we—researchers, deliverers of services and policy makers, volunteers, as well as professionals—are asking the necessary types of questions. The cyberneticist Heinz Von Foerster posited that there are two types of questions: illegitimate questions and legitimate questions. The former are those for which the answer is not known. An illegitimate question is one for which the answer is known. (“Doomsday; Friday, 13 November, A.D., 2026,” Science, 1960, 132, pp. 1291–1295.).

8 With the advent of artificial science and its theoretical underpinnings (chaos, complexity, and uncertainty theories), it is now posited that much of human behavior is complex, dynamic, multidimensional, level/phase structured, nonlinear, law-driven, and bounded (culture, time, place, age, gender, ethnicity, etc.). The misleading traditional linear “either/or” conceptualizations are realistically considered as “and/also” for a range of behaviors and processes. This is not a semantic issue. There are two important issues to consider and which are derived from this: (1) using linear models/tools to study and understand nonlinear processes/phenomena can and does result in misleading conclusions and can therefore also result in inappropriate intervention; (2) the concepts prediction and control have different meanings and dimensions than they do in the more traditional linear “cause and effect” paradigms. Editor's note.