Libri di Psicoterapia Integrativa

In reviewing Relational Patterns,Therapeutic Presence, I am acutely aware I will likely miss out aspects of the book, for this is a review and not a condensing of the work. I find this in itself nteresting, noting what I have not included. The book undoubtedly offers a relational therapy approach. Aspects of what Erskine describes as Integrative Psychotherapy bear some correlation with Neuro-Linguistic Programming (NLP), which isn’t surprising given the latter has some of its roots in Gestalt therapy, which Erskine also draws upon in this work.

The key themes explored through this book are attunement, the transferential domain and unconscious patterns of relating, with Erskine linking attachment patterns (Bowlby, 1979) to script, script protocol and palimpsest (Berne, 1966). Relational Patterns, Therapeutic Presence has a focus on script psychotherapy. To quote Erskine: ‘In the psychotherapy of life scripts it is important that the psychotherapist understand and appreciate that life scripts are a desperate and creative attempt to self-regulate while managing and adjusting to the failures that occurred in significant and dependent relationships throughout life.’ (p111).

Erskine makes much mention of therapeutic involvement and attunement. Maybe we all have our own understanding of what this means, however Erskine makes clear through the examples given that therapeutic involvement is more than just being present with a client. My understanding is therapeutic involvement means paying attention to the client, to oneself and to the relationship. To properly attune to the affect and rhythm of the client, involvement is more than listening to words; it can include hearing what is not said as well as that which might be hidden or encoded within words: signs from the unconscious. Erskine encapsulates for me a vital rule for any therapist to remember, and why I often struggle when hearing elaborate therapeutic interpretation of a client’s experience. Erskine states (p161) that he ‘... knows nothing about the client’s experience or inner life, his observations and theories are mere impressions. The impressions alone do not tell enough about what it is like to be in the other’s experience. Therefore ongoing phenomenological inquiry is required to discover the client’s perspective, feelings and what they need in a therapeutic relationship.’

In his writing Erskine is faced with the challenge of putting into words how he attunes to the client, what I regard as paying exquisite attention to a client. Over the course of the book, an understanding of what attunement is, and the therapeutic benefits of it, develops. Chapters one to three offer a theoretical perspective on integrative psychotherapy through attunement and involvement. Having set out an initial theoretical perspective, Erskine continues in subsequent chapters to soundly illustrate the ideas presented with both case vignettes and transcripts which bring the theory presented to life. In thinking about script, Erskine suggests that script formation subsequently informs the infant’s frame of reference. Perhaps this will seem obvious to some and yet it wasn’t something I had previously considered. Once formulate and adopted, script beliefs influence what internal and external stimuli are attended to, how they are interpreted, and whether or not they are acted upon. A notion I suspect I will find helpful in my clinical work.

I particularly like the theory the book offers on script, describing script as an unconscious organisation of experience. Erskine offers an additional and complementary view to classical theory on script,suggesting that script is more than explicit decisions. ‘Not all life scripts are based on parental injunctions or script decisions, contrary to what is emphasized in much of the literature on script theory. Unconscious conclusions based on lived experience account for a major portion of life scripts. Implicit experiential conclusions are composed of unconscious affect, physical and relational reactions that are without concept, language, sequencing of events, or conscious thought. (p96).

In my own practice I have always paid acute attention to a client’s affect, physiology, words, metaphor and much more. I assumed that much of my own style was because of my NLP and clinical hypnotherapy background. This attention to the client is always therapeutically important for me, in order to gain insight into the client’s internal experience. Now Erskine has helped me understand with his integrative psychotherapy approach why such attunement to the client is vital to decoding a client’s script decisions and relational patterns, in order to offer an effective psychotherapy. His writing places a great deal of emphasis on the unconscious encoded information from the client carried into the therapeutic relationship. Through attention to the therapist’s own process, and to valuable yet often subtle physiological clues, the client’s script beliefs can eventually be identified. Through contact and skilled attunement from the therapist, the client’s early implicit decisions can be bought to Adult awareness.

Erskine pays much attention to that which is hidden, and yet is there to be discovered, for the skilled relational therapist, by paying attention to body language, transference, body sensations and the client’s story. This is about listening to more than what is said. This is about attunement to the client as a way of understanding script decisions and beliefs. Relational Patterns, Therapeutic Presence deals at some depth with Child and Parent ego states. I found it particularly helpful to read the ideas presented for working with the intrapsychic conflict caused by introjection of the Parent.

Through the later chapters of the book, Erskine offers a brief review of existing theory of the Parent before developing his own ideas and presenting them within the cases of the ‘devil’ and Anne-Marie. The importance of his therapeutic relationship, his patience and the safety he provides is of itself worth a specific mention I feel. While understanding the importance of establishing a good working alliance, I found it both helpful and surprising to read Erskine’s case examples and note just how long he often gives to developing the therapeutic relationship, eighteen months being given as an example.

To summarise, I have found this book helpful to have as a theoretical framework and validation as I develop my own style of psychotherapy. It is one of the most helpful books I have read in terms of furthering my own psychotherapeutic practice. The one question I have is whether Erskine’s integrative psychotherapy approach can be useful for any short-term therapeutic work. While I am sure there will be those who disagree philosophically, I find it helpful to hold in mind Erskine’s belief that script cure is the primary goal of an integrative psychotherapy. To borrow a phrase from NLP this is ‘a’ rule it is not ‘the’ rule.

References

Bowlby, J. (1979) The Making and Breaking of Affectional Bonds. Oxon: Routledge

Berne, E. (1966) Principles of Group Treatment. New York: Grove Press

John Paradise is a Transactional Analysis psychotherapist (in advanced training) with a diploma in clinical hypnotherapy, he is also a Neuro-Linguistic Programming (NLP) practitioner. He has his own private practice in Exeter and works voluntarily at the Iron Mill College in Exeter.