Re: Treating Symptoms

Pete,

We do not ignore the client's request for help with symptoms. First, however, we should determine if the symptom has an organic cause, by suggesting a medical checkup. (For example, anxiety may be related to a thyroid problem.) We can then proceed to check for a psychological influence. After responding empathically to the clients distress, we usually try to find out the genesis of their symptoms: when they started, and what was happening at the time. Generally, symptoms begin when an individual is not prepared to meet a life task, and begins to feel the shock of his anticipated failure. Sensitive or inferior may organs reflect the increased psychological vibration of acute or chronic negative feelings and emotions. Often, we can trace the prototype of an adult's symptoms back to childhood (i.e., the use of crying to secure attention and service).

Clients are often ambivalent about giving up their symptoms. On one hand, they may be suffering more intensely compared to a previously tolerable level of distress (the benefits of the symptom are no longer worth the price); on the other hand, if they give up the symptomn entirely, they may feel obligated to face a challenge that the are not prepared to meet. The trap, for the therapist, could be focusing on managing or reducing the symptom to the exclusion of addressing the challenging task or responsibility. It is not too difficult for a client to declare war with two sides of himself, wage a heroic "side-show" battle with a symptom that he has created, and emerge an exhausted warrior who has no energy left for the events in the main arena of life (work, love, friendship).

Alfred Adler expressed the purpose of symptoms succinctly:

The neurotic symptom has to fulfil three very important functions: It has to serve as an alibi for failing to accomplish what would bring about the craved triumph. It makes it possible to postpone decisions. It permits greater expectation of appreciation for smaller achievements, as these had to be worked against the impediment of suffering.

Lydia Sicher also offered useful insights:

The moment that an individual approaches his problems with the feeling that, "If it were not for my symptom I could do this or that," the purpose of the symptom is quite evident. The symptom itself may affect the body (functional neuroses) and lead through chronic abuse of the organ to real diseases. Or it can lie in the field of thinking, expressing itself in doubts, scruples, fears (obsessions), in the realm of feeling with emotional outbreaks in anger, self-pity, despair, (moods). Or it can be in the sphere of action as raptus, fugues, rituals (compulsions).

Whatever the symptom, it always proves that there is fire burning under the surface of which the visible smoke is the symptom. The problem that the individual fears to face can often be unveiled with the question, "What would you do, if you did not suffer from this trouble?" The answer mostly indicates which situation in the individual's life is menacing his self esteem, or at least so in his own estimation.

If the individual would produce his symptoms voluntarily, he would not be neurotic but a swindler. But he does not know about the deep inner fight that is going on within himself although the faulty attitudes are constantly trained in apperception, dreams, memories.

A cure of the symptom alone without the treatment of the whole person will be necessarily unsatisfactory and mostly bring relief for some time only.

Medication can sometimes reduce a disabling symptom sufficiently for therapy to proceed; however, it may also mask a problem and reduce the incentive to discover and dissolve the root of the problem. Reducing the client's distress is often a priority, but some level of that distress can be used to promote a change in behavior and attitude. We must also consider the negative impact of the client's behavior on others.

Unless the therapist eventually perceives the purpose of the symptom, the reduction of one symptom may lead to the creation of another one. (Adler suggested that either manic or depressive behavior could be used for the same purpose of annoying people.) I had one client who studied psychology texts and developed a remarkable sequence of symptoms. He was intent on proving that no therapist would be able to cure him. (He had already "defeated" several therapists.) As soon as one symptom seemed to subside, a new one would emerge. When I told him that I didn't think that I could do anything about his symptoms, but that I could teach him some new ones, he looked quite surpised and started laughing.

Replies:

Re: Treating symptoms, by Pete Gambino, 4/28/97 Re: Symptoms and Change, by Henry Stein, 5/1/97

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