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The 42st National Conference of Child and Adolescent Neurology and Psychiatry and Allied Professions with international participation


POSSIBILITIES OF AN EXISTENTIAL – ANALYTIC APPROACH TO ADOLESCENTS WITH SUICIDAL BEHAVIOUR

Autor: Lorica Gabriela Gheorghiu
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The suicidal conduct in adolescents was, is, and will always be a challenge to find ways to address those who just contemplate or even perform this act of throwing themselves into nonexistence, and, at the same time, to experience psychotherapeutic formulas meant to prevent this phenomenon. In the first part, I will try to detail the method I use to relate myself personally, as a psychotherapist with existential – analytic training, to this phenomenon, starting from a few excerpts from the diary of a teenager written during the period when her decision to commit this suicidal act took shape, following a disconcerting inner dialogue. Further, I am going to present two cases (intervention in suicidal crisis and, respectively, in post suicidal act) which illustrate some options to address the existential-analytic approach. These endeavours were different in magnitude and method, and were structured according to the challenge of the suffering, always unique, of the one who calls for help. In the last part, I will present a model of group therapy, inspired by the existential-analytic approach, designed with the intention of preventing suicidal behaviours in adolescents, and experienced for a period of 18 months at the Light Centre in Timisoara, the headquarters of the Society for Existential Analysis and Logotherapy from Romania.

Introduction:

MM, a teenager that I had in therapy after she

returned from a coma following a suicidal act, towards the end of therapy, offered me the pages of her diary from the period preceding the act, and she told me: “These are my disquietudes … maybe of others, too, who want to be helped. I would like it to be a gift for them! It may help you understand better!”

Here are just a few excerpts from this diary: “It seems that spring is here and did not even notice! My soul is alone, suffocated by so much despair. … I have not found anyone who could understand me! No one has made the slightest effort to approach my inner person! It’s so hard for me to pretend that I feel well … I would like to scream, so anyone should f ind out what I feel and cannot express in words … I do not have the strength to f ind my way in life … I am confused and feel sorry for myself. Might there be anyone who could guarantee that I will not become a failure? Perhaps it would be better to die because I would do good for me and for those around me … I would only have one more wish. I should join the Red Cross of Serbia (December 1998). If I die, nobody would say that I had passed through life for nothing”… “Soon I will die! I am determined! Life is too hard a struggle for me!”; “And I might struggle but I do not know for what …. Just to do my duty towards others, outside me? If I cannot live for me why should I live for others?”; “It is only my fault… I’m afraid I’m a big scrap of nature… my existence on this earth is worthless … maybe even harmful … I do not think I have brought joy to anyone, although God is my witness that I have tried …”; “… I’m angry with me, I hate myself from all my heart … I am a monster… I despise myself so much and I am thinking only of suicide!”

After a few months of therapy, the patient noted in the diary: “I think have never, ever really wanted to die! My act has been a desperate cry. I needed help!”

In clinical practice, this desperate cry for help, for understanding is not as visible as in these diary frag- ments. Most often, the patient’s presence at a psycho- logic or psychiatric consultation is masked by invo- king the most mundane reasons and sometimes, even by the display of exaggerated and provocative self-as- surance. It feels like the last test of the possibility to be felt, understood and helped.

It is important to catch each verbal and behavi- oural detail to perceive the message of the teenager who is in such a critical situation: “I need help. I need someone who might understand me, and help me so that I could be able to feel the light which seems to exist outsi- de the tunnel where now I’m suffocating in despair and suffering!”

Helping a suicidal adolescent to travel from the tunnel of despair to this “YES to LIFE!” declarati- on is a difficult enterprise, which involves not only an arsenal of techniques and methods (regardless of training in psychotherapy), but, above all, a certain attitude that comes from the way the therapist relates to Life-Death theme.

First, it is inside you, the therapist, where that scream “YES to LIFE!” should be heard, in order to instil this message to the person who is calling on you.

Equally important is the way you perceive the su- icidal phenomenon in the adolescent, beyond all aeti- ological approaches.

“Looking phenomenologically at my relationship with the Life-Death theme and at my openness in front of the challenge launched by the suicidal adoles- cent to be present and to assist her in a psychothera- peutic endeavour, I realized what I actually see when I look at some of these leaps into non-existence. I see LIFE, yearning for the sacred fire of authentic being.

And I say YES! I am present here for Life!”

It is an approach, like a trip on the narrow ridge of a crest, on which I advance, attentive to my partner that I agreed to accompany with compassion for his/her suffering, guided by love and respect for life that wants to be lived differently and everything happens at a level of feeling hard put into words.

In some adolescents, the act of suicide seems to have the human being’s aura of freedom to act, following a decision loaded with the weight of the intense combustion of inner dialogue, of the confron- tation with oneself and with the world. This decision takes them gradually to the edge of abyss, into which they throw themselves like daredevil climbers, in order to feel the possible Transcendence, which lies in them.

Adolescence is the period of spiritual awakening. Becoming aware of the spiritual coordinates of their beings, Freedom and Responsibility, adolescents may be lured by an exacerbation of their burden in this existence. Against the background of existenti- al unrest and faced with the negative quality of life (family problems, financial difficulties, the experience of rejection, loss, false paths, and wanderings, often combined with the reading of nihilistic philosophi- cal texts) they may synthesize an extremely negative stock at the pole of “TO BE”.[1]

M. M. noted in her diary: “I’m angry with myself ! I hate myself ! I despise myself ! My existence on this earth is futile! I am weak and do not want to end up a loser. If I chose to live, it would mean to f ight windmills, but I do not have the strength to f ight the evils of an enti- re world.” These notes might evoke the living of the melancholic, described by V. Frankl: “The conscious anxiety of the melancholic is born out of an intrinsic human feeling, that of the high tension between the need and the possibility of its fulfilment … The initi- al blindness, that may be focused on one’s own Ego, progresses centrifugally, blurring the assessment of all reality.”[2]

The current personal value, despairs the adoles- cent, because it does not help her in her heroic self- transcendence of which she feels concerned. She feels called like a God, but simultaneously she perceives herself as a void.

Negative perception of personal worth throws the adolescent into depression. Mobilization and stren- gth for the suicidal act come from the Ideal Ego. In the confessions of suicidal adolescent, the existence of dissociative type feelings seems obvious: the real ego, trashy and powerless and the ideal ego, strong, with messianic capacities. Anger against the real ego reaches impressive levels in suicidal crisis and belongs to that Ideal Ego who assumes the right to an extreme act of freedom and assertion.

If in the seemingly more peaceful process of inte- rior, maturating revolution of adolescence, the turmoil on the issue of self-acceptance and of authentic affir- mation in life, reminds us of the sacred, cultivated and controlled fire that sustains life, in the suicidal act, fire seems to be proliferating and destroys everything in the hope of an ascension into being.”[1]

The two cases that I will present, of intervention in suicidal crisis and respectively in the post suicidal act, illustrate some options to address existential-analytic approaches, different in magnitude and method, whi- ch were structured according to the challenge of the suffering, always unique, of the individual who calls for help.

I will also present a model of group therapy, in- spired by the existential-analytic approach, designed with the intention of preventing suicidal behaviours in adolescents, and experienced for a period of 18 months at the Light Centre, in Timisoara, headquar- ters of the Society for Existential Analysis and Lo- gotherapy from Romania.

All specialists who have suicidal adolescents in therapy know that there are no methodology recipes. Each case is unique and it is important to be flexible and open to be able to see that unique challenge.

The Case of C.C.

The father, who is alerted that he had found a kni- fe and a bottle of sleeping tablets under his daughter’s pillow, brings the girl to hospital. She would not talk with him about this issue but she wanted to see a psychologist. The girl has a general tremor, smokes

cigarette after cigarette and is staring at me attenti- vely, with a look that seems to punch shear and cling. I have the overwhelming feeling that I am the hook, which a desperate climber has hanged the rope on and I make an effort to be able to resist. The girl does not speak anything minutes on end, and is just staring at me, as is testing my ability to resist.

I ask her if she remembers a dream that she had repeatedly or which astonished her. Suddenly she be- comes more relaxed and retells two dreams that had really given her food for thought:

1. She is on the balcony of an apartment without railing and crawls on her belly terrified lest she might slide in the void.

2. She plunges off from a cliff to another, barely catches, feels that she slips and tries to jump to another cliff. She always wakes up sweaty and desperate.

I try quickly an interpretation of these repetitive dreams and say: “It’s like you are looking for a secure, firm support to hold you, to rely on, to protect you and you do not find it.” She manifests a sudden chan- ge of attitude. She looks down and tells me spontane- ously about her parents:

Mother, preoccupied with paranormal literature, suffocates her daughter with her ideas even since she was a little child (“Everything around is dangerous for her … demons, aliens”). Though she lived more in Serbia, with the stepsister aged 22 years, mother used to show up suddenly at the patient’s paternal gran- dmother who was bringing her up, to take the girl and teach her life lessons in terms of her views, and dissatisfied with the lack of impact, she would throw her back again to the grandmother.

After the divorce, (which happened when the girl was 10 years old) father lived in cohabitation with a young woman of 30. (“I ignore her … I do not think she has anything to offer me!”). The girl avoids going to her father’s house, and, since he was very busy, they would meet rarely, at the grandmother’s house. They did not use to communicate, or spent their holidays together. The girl says that she was struck by his alert when he found the pills and the knife and her face lit up with joy when she said this.

After a long period in which the mother did not show up, she suddenly came with the girl’s stepsister, found her diary and, in her “sick, paranoid” style of thinking, concluded that the girl takes drugs and she announced the police. (“She did not let me speak! I couldnot stand it! … I wanted to get out of this awful state! … I would have killed her or I would have killed myself !”).

She recalls that around the age of 7, terrorized by her mother’s ideas, she used to keep a knife under the pillow, with the intention of ending this unbearable situation somehow. (“I used to feel well at my grand- mother, but she would come, without notice, haggle with grandma, and take me to her without considering what I wanted, what I felt! It was like I did not exist, she would not see me, listen to me, or believe me!”).

I declared that I admire her for her strength to confront these manifestations of her mother for so many years, and that I understand her suffering, and how she felt, not having the chance to have a partner for authentic dialogue who could give her the feeling of safety and support and induce her the joy of being.

She knew that the mother had a mental problem and that she had multiple hospitalizations. She tried to learn about paranoia, but wanted more accessible and more comprehensible explanations for her.

C.C. took me involuntarily to the first step in the Personal Positioning (P.P.) (A.Langle) [3] namely the external positioning. Through informational counselling, at this moment, a new, distancing ope- ning was obtained, which offered a kind of protec- tion against the anguishing situation, whose victim she was. Obviously more relaxed, she sighs and says as if speaking to herself: “ Yes! Mom is sick!” She looks up at me and says in an almost imperative tone: “I would like you to do me some tests! I wanna know what’s wrong with me!”

The road to the second step of P.P. (inner positio- ning) was open. It was time to look inward (to the as- sumptions, fears, expectations, demands, fantasies), and to proceed to their relativization, thus facilitating self- distancing and then highlighting personal resources.

Several meetings followed during which I admi- nistered projective tests, personality questionnaires, Existence Scale (A.Langle, C.Orgler) [4], which emphasizes personal skills in relationship with the self and with the world. I also used Existential Ima- gination (W.Popa) [5]. The patient used to participa- te in these assessments and self-awareness exercises conscientiously; she was interested in interpreting the results. She was very attentive and stared at me with the same piercing look she had at our first meeting. She would not ask any questions, nor did any com- ment. There were meetings where only I spoke, and I often felt like an acrobat who walks on a tight rope without safety rope, and feels that any wrong move can turn the show into a tragedy.

I invited her to come to the self-discovery group that had started some days before at the Centre LU- MINA. She replied immediately – “Please do not leave me! I feel peaceful here!” I understood that she needed someone’s presence to provide comfort and safety for searching the self in silence.

She finally came to a few meetings of the group, but it was just a spectator. She continued to come to my office, and agreed to talk about the relationship with her father and current wife. It was time for her to consider another possible relationship that would provide her with support and stability. She managed to go on a few short trips, 1-2 days, with her dad and his wife now, went shopping, to the hairdresser’s with her stepmother and was glad that they were leave to- gether for Greece during the holiday.

Upon returning from vacation, she called me to announce that she comes on a short visit. She wore a colourful dress, and had a feminine haircut. She was thrilled by the vacation she spent and by how she felt in the company of her father’s current wife (now she called her by name) as near “an older sister, highly avai- lable and understanding”. She had also met a guy with whom she had been into a relationship for several weeks. She said that she wanted to tell me about a dream she had a few days before: “It seemed I had su- pernatural powers and I took you and my friend in a fli- ght to the roof of a tower block. There it was a huge green box that I could not wait to open.” I realized she felt that YES for life! And she wanted to share this feeling with those who helped her get here, and I confirmed this feeling to her. (It was step 3 in P.P. – openness to the real values.)

The patient went away in a serene mood, a little exalted by the joy of this experience: I can and it feels good to be!

After a few days, she called me, slightly agitated, requesting a meeting. She said she was a little confu- sed. Shee does not understand why she feels the need to buzz her boyfriend, to challenge him, to tell him something different but what she feels, and even to pinch him literally with no reason, although he was very loving, honest and understanding.

I tried a phenomenological approach to this situation and I concluded: “I still test the ability of a partner to bear with me and I’m afraid to express myself authen- tically so as not to be betrayed!”

Spontaneously, she recounted several instances from her childhood, when mom and sister, telling her that she can trust them, a challenged her to make some confessions, only to retell them to others, in their own interpretation. I push forth and I ask: “How did you feel when you were cornered?” – “Terrible”! As if I did not have a place in this world … I felt I wanted to go away!” At that moment, she smiled and her face brigh- tened. She had understood what she had to do.

”To help someone feel the JOY of life, it is not enough to say that they exist but you should help them feel this joy inside themselves.”

Some conclusions on intervention in suicidal crisis:

Meeting with the person in suicidal crisis is a request for intense emotional and empathic participation.

It is the challenge of a desperate man, to under- stand the suffering that overwhelmed him, and his powerlessness to ever find a solution. It is a request for genuine presence, willingness to understand and respect the despair of the person who seeks assistance.

Communication and networking with a person in suicidal crisis is not easily performed. Most often, you, as a therapist, feel that your abilities to abide, to be truly resonant with the patient’s suffering and to help him really are tested. Every such meeting is a mirage pertaining to the authenticity of your ability to per- ceive a gateway for communication with the one who requests you, to the empathic abilities and perhaps, primarily, to your vitality that may guarantee the fact that you are able to help. If a genuine “YES for life!” echoes inside you, as a therapist, then you will cer- tainly find a way to help your patient. During the first meetings, you may notice elements, which can help you evaluate the magnitude of the psychotherapeutic endeavour required in each case: where the suicidal impulse is due to unbearable conditions, it is impor- tant to help the patient realize that one can live in spi- te of all the difficulties (Personal Positioning -P.P. is a method of mobilizing resources. By supportive pro- cessing of the feelings it facilitates self – distancing, breaking constraits, through a false assessment of the situation and involving the person in it) (A.Langle) [3]; where you feel it is an act of decision that carries with it the combustion of high intensity of an inner dialogue, of confrontation with oneself, this requires a broader approach, intercommunion with the person: Personal Existential Analysis (A.Langle), Existential Imagination (W.Popa), Biography Work (A.Langle)

The Case of M.M. [1]

This case illustrates the second situation of psychotherapeutic endeavour mentioned above. The diary fragments cited early in this paper belong to M.M., and, along with many others, they show an intense inner turmoil that led to the decision for a suicidal act.

M. M. used to live in a small town at the beginning of the ninth decade. It was prosperous economically (in a mining area), also a small cultural centre. After almost ten years, the atmosphere had a completely di- fferent flavour: many unemployed after the closure of the mine, numbness, gradual annihilation of the old moral and cultural values, domination of the value of money and of the elite of the newly rich who obtained this position quickly through border traffic.

I did not lose a job but a world!” said the girl’s mother, a strong and independent woman with na- tionally recognized professional status in the field of research and an unwavering system of moral values, whose aura encompassed the entire family.

Father was a researcher, too having been dismissed some years before. He had serious problems with the lungs and for years, the whole family lived the night- mare of tests and protection treatments.

M. M. was preoccupied with reading, sports and a lifestyles governed by her mother’s moral values, winner at the Olympiad of humanities department, enrols on the Computer Studies section – which see- med to be elite, and was totally disappointed with the quality of colleagues. She is carried by a colleague, a sort of class celebrity to the worldly life of the city. (“She had become my connecting bridge to the dirty world that I used to hate and covet at the same time. I started to imitate her, to behave like her.”).

In the summer holidays, she went on a trip in the mountains with a group of young people from another town. She returns home delighted by these youths, guided by other values, and she told her mom that she was tired of the gutter of her colleagues, but she felt doomed to suffocate in that environment. Mother noticed that her daughter was increasingly less pre- sent in the old entourage, had meditative periods, re- treated increasingly into her room, was not interested in her future academic life, although the baccalaureate exam was approaching. After a while, everything se- emed to be as before. She used to go out with friends daily, and was concerned with physical appearance. She went with her parents to the countryside when she suddenly left for the town with the last coach, motivating that her friends were waiting for her at the discotheque. The girl confessed that she had plotted this strategy to be alone at home and accomplish her suicide plan. In a detached manner, she had reviewed several ways to commit suicide. Mother had a pre- monition. She was awakened suddenly by a feeling of suffocation and went to town, where she found her girl in coma. Under her pillow, she found a diary whe- re she discovered the girl’s disturbing dialogue with herself, which went on for months.

It is the second day of hospitalization in our section, after a relatively short time from coming out of a coma, three days after the ingestion of over 100 di- fferent tablets. The patient comes into cabinet alone, greets, introduces herself, and approaches the window, looks out attentively and comments: “I am quiet! I feel well! … I see a bit of heaven! I love it! I saw a flock of birds flying! It is autumn! I’m excited! The sky is reddish … I feel that the sun will rise! The trees are still green! I love everything around me! I feel everything! … But it seems that I cannot express in words. It is as if was born now! Now I feel! So far I struggled to understand … Now, I try to express in words what I feel!“ She has a serene attitu- de, looks carefully at everything around, enjoying all that life has to offer. Her speech has a firm tone, calm, clear, filled with the naivety of a child but perhaps with the wisdom of an elder, too.

Coming near the desk, she sits and draws a simple sketch: A ………………… .B and explains:

Here in A I was born and here in B I committed su- icide. Everything starts here in B. Actually I was born here, and I try to live step by step!”.

At this moment, the therapeutic approach is clear! The patient has formulated a discreet, but firm request to be with her: “I am a newly born baby and I need you to grow up!”.

However, there is also a bargain: quiet, calm sa- vouring of all that life means, that is happening in front of your eyes and that gives you, as a therapist, a chance to experience the power and the fundamental value of life.

The jump, in a literal not imaginative manner, through the “Gate of Death” has led to fascinating feeling of the reason of Being, the fundamental value of life.

Psychotherapeutic approach was outlined while listening to this appeal of the patient, for authentic experience. Placing her on her Own way could be done through rational discussion, but primarily by causing authentic experiences. I proceeded alongside M. M. on a difficult path, to reopen access to a personal life history, now denied, to restore the link with mea- ningful and authentic experiences from her past, on another level of feeling and understanding.

A biographical approach has emerged stimulated by the method of Existential Imagination. (E.I.) [5]

This approach allowed:

Access to a life history that the patient refuses to see anymore. Authentic life experiences in E.I. sprou- ted, grew and filled a painful gap in life.

Encompassing forgotten personal emotionality; this has opened for her again the way toward the vi- tality felt in childhood (bathing in a mountain creek, rolling in the dew-covered grass or feeling the smell of hay in grandparents’ attic …)

A phenomenological search and a stand in front of situations felt as foreign, irritating, disturbing; the increase of the capacity to delimitate oneself, to grasp and assert one’s own Self.

The flashes of living and wonder triggered by Existential Imagination have awakened from num- bness experiences of authentic living, brought a vi- talizing infusion to the traveller on this road. The biographical gap was filled with authentic life experi- ences and the irritations from the images have created an opportunity for delimitating from fake errors, for taking attitude and action.

The leap from the false to the authentic and per- sonal appears as evident in the double images at the main themes of Existential Imagination:

E.I. Theme – FOUNTAIN

I. An artesian fountain of pink gems like in the movies,

II. A stone fountain, in the grandparents’courtyard, surrounded by green grass, from which a bucket with cold water emerges.

E.I Theme.- ROAD

I. A white marble road, where the patient makes her way with difficulty, slipping at every step, irritated by loud noise of the camp of gypsy goldsmiths.

II. The path, from the little hill behind the gran- dparents’ backyard, on which she used to walk to the village cemetery, where she found peace, tending the flowers on the graves of relatives. ( “I have never been afraid there! I used to imagine stories of their lives and felt I had roots on this earth!”).

E.I. Theme-TREE

I. A tree like in fairy tales, with gold apples shining

in the sun that she could not grab.

II. The apple tree of the species “Golden”, in the grandparents’s backyard where she used to hide in or- der to read or write in the diary. ( “I felt overwhelmed by their smell. There was my Heaven!”).

It was a long way (over 12 months), with many vitalizing ups dangerous downs (crises), especially in the first period of hospitalization and after returning to the patient’s hometown.

The hundreds of pages written in this period were for me, as a therapist, a gift that facilitated understan- ding and intervention, and for the patient, a possibi- lity of expression with therapeutic significance.

Ive had two crises today, too I feel that another is on the way … but I know I can overcome them. It is as if a war is fought inside me. I try to establish the camps: I and what is contrary to my ego; good angel, bad angel. When I manage to strike a balance between them, I will know that I’ve made it. The f ight is with myself, not with the others!”

“I need peace! Mothers, children bother me … I just want to work with those with whom I feel they can help me make light in my chaos! I need peace and time! … This is an inner f ight! There are two camps: I, the one that feels and understands all that is contrary to my ego – Mothers, children, hospital rules, the animal-instincts- man-judgment. The animal is frightened when there is noise, agitation, but the man tries to calm him, it f ights and then there is a crisis.” “Now I understand how one may tame the most ferocious animal! If you stand still and you transfer calm, you can get it to befriend you.”. “Some- times I struggle like f ish out of water, but I have faith that a wave will come and will pull me in the open sea where I am saved!”

“I’m hectic, because I am not patient enough to tell Mrs. Psychologist that I progressed. I need quiet … I’m tired and nobody believes me … as if everybody sends me away! Today I do not want to talk to anybody. I cannot do this anymore!”

“Today I had three crises … the crisis is foreshadowed by the feeling that I understand everything and nobody understands me … if I am left alone, it passes quickly, if someone intervenes with consolations, it extends … I want to be left alone!”.

I think I progressed … I no longer feel the need that the others should be quiet. It is only me who can make silence inside me.”

I feel that I can accommodate, I can accept! Staying with kids, I listen to them and I remember the beautiful

times of my own childhood I started to have good me- mories of high school, too. It is a period during which I wrote that it led me to suicide … I’ve made a new sketch of my life, each marked by one motto:

Childhood Adolescence Present
Love Authenticity Nature “We have the remorse of not being gods, as if it were in our power to become!” “Humans complain that there are thorns among roses instead of

rejoicing that roses blossom among thorns”

“I seem to grow up in one day as others in one year! Now I feel like being 10 years old … I’m worried that I will leave the hospital. Here I felt that a strong wave has approached me to the sea … but there is still a long way until reaching the sea … until I find my inner peace. I died, but I was reborn from my own ashes like the Phoenix bird … Here I recovered many years of my life! I love myself ! I love myself !”

Soon enough, the return to the native environ- ment had destabilized this crude and incipient stabi- lization. The patient was still a child, who needed her companion to process the realities and act from her new, barely won position. He had meetings every two to three weeks to gradually relax the pace of these me- etings more and more, and with every meeting, I used to receive several diary pages. (One of the last notes: “I feel that life is beautiful! I’m free! I am myself ! I’m glad I am!” [1]

Reading the diary pages offered by this teenager toward the end of the therapy, but also many other cases, perhaps less generous in communicating the unrest that led to the suicidal act, challenged and mobilized me to outline a group therapy, inspired by the concept of Existential Analysis, with preventive valences.

Modules PSY I and PSY II designed by Dr Alfried Langle for self-knowledge group with medical per- sonnel, was an incentive and a basis for structuring, together with my colleague Dr Simona Stefaniga, a psychotherapeutic approach for adolescents with su- icidal risk. I was trying to answer a double challenge: that of the adolescents hospitalized in the clinic, who on discharge, frequently expressed their need for furt- her meeting, communication, self – knowledge but also a personal and professional target, i.e. to experi-

ence an approach with preventive valence in adoles- cents with suicidal conduct or other existential wan- derings.

To start this process it was necessary: to design a systematization and structuring of group interven- tions performed in the clinic under time pressure; to find a location outside the hospital (Light Cen- tre, SAEL, generously put one at our disposal by our mentor MD W. Popa for the work of all members); and a period of time dedicated exclusively to these group therapies and that should be appropriate for both participants and psychotherapists (on Fridays from 15:00 to 18:00).

The strained adolescent, placed in the arch betwe- en TO BE and TO BE ABLE, released like an Icarus, very often awakens that he has landed on top of a rickety building, with many gaps and vulnerabilities (anxieties, losses, disappointments, failures, humilia- tions.). Most frequently he has sight directed towards the light of a huge target but a collapse may become possible, suddenly or gradually.

Such psychotherapy approach, is meant to be like the intervention of a civil engineering specialist in designing the strength of building materials i.e. hel- ping to detect possible weak points and strengthen weaknesses at all levels). This approach was structu- red according to the theory of the four fundamental motivations of Alfried Langle.

The theory of the four fundamental motivations

(F.M.) Alfried Langle [7]

Current existential analysis distinguishes four fundamental personal-existential motivations (A.Langle), that must be fulfilled as a scale of beco- ming, for the person to arrive at authentic existence:

1. To be able to EXIST (which involves the answer to the fundamental question of existence: (I am here. Can I be? Do I have the necessary space, protection and support?) Through perception and cognition lea- ding to F UNDAMENTAL TRUST;

2. To enjoy the VALUABLE – To love LIFE (I am alive, but do I like to live? Do I feel my emotions and experience the value of my life?) Through emoti- on leading to F UNDAMENTAL VALUE;

3. To be allowed TO BE ONESELF (I am me. May I be myself ? Am I free to be me?) Through atti- tudes and identifications leading to ONE’S OWN VALUE;

4. The WILL (readiness) for MEANING (V.FRANKL) (I am here. What am I here for? What do I live for? What gives my life meaning?) Throu- gh action, commitment and dedication leading to the MEANING OF LIFE.

“If the fulfilment of each basic condition of exis- tence in part fails, fundamental existential feelings will appear that, once mentally perpetuated, respecti- vely deposited, will become increasingly burdensome thus triggering mental disorders.” [7]

In structuring this psychotherapeutic endeavour, we found inspiration in modules PSY I and PSY II, designed by MD A. Langle for a self-knowledge group of medical staff, divided into four blocks of 3-5 days. I have adapted and developed the modu- les for long-term exertion with adolescents who were to take part and I have completed the structure of these modules, when the situation required it, with other processes and existential-analytic methods – to make the resentment of the topics addressed more accessible and to develop them. We mention some of these methods, presented by Silvia Langle in Metho- dological Structure of Logotherapy and Existential Analysis. [6]

Processual methods: Personal Existential Analysis – PEA- (A. Langle); Existential Imagination – ini- tiated and masterly implemented by our trainer and mentor, MD Wilhelmine Popa

Methods to challenge and mobilize resources: change of attitude; personal positioning; fortification of volition; biographical approaches.

PEA – is based on the processual concept of the person. The person exists in a dialogical exchange with the world through 3 steps, which mark three fundamental capabilities of personal encounter and create interior (sub- jective – intimate) as well as exterior (relational) access of the person. These three form a unity both in the dialogical encounter and in the subjective experience. [6]

PEA steps:

PEA 0 – preliminary descriptive stage – descripti- on of content and facts. Therapist’s attitude is cogniti- ve; Creating a relationship.

PEA 1phenomenological analysis – concretiza- tion of impression (primary emotion and phenomenal content). Therapist’s attitude is empathic.

PEA 2 – processing of impression and taking inner attitude (integrated emotion). – Therapist’s attitude – confrontative – relational

PEA 3 (self-actualization) – f inding an expres- sion, an adequate response, action. The attitude of the support therapist- encouraging [6].

Existential Imagination initiated and practiced by MD Wilhelmine Popa, aims at a holistic approach to complex personal reality allowing the unconscious spirituality to speak aloud.

In a state of deep relaxation, during the reverie, the person who imagines lives his own life, in all its full- ness and authenticity. Here, the most diverse percepti- ons (visual, auditory, olfactory, tactile, kinaesthetic…) play a particularly important role. From the unexplored depths of the self, wonderful encrypted messages emerge, addressed to this yet perfectible self. They widen, deepen, and thus complement the patient’s own image, revealing oneself in this self-image.” [5]

“Imaginative processes represent a specific kind of phenomenological analysis, addressing Self-distan- cing and Self-acceptance. They are more appropriate than verbal interaction for certain patients and the- rapists. The next steps of PEA for a genuine restruc- turing may be obtained both through continuing E.I. and through classical processing.” [6]

Two psychotherapists (Psych. Lorica Gheorghiu and MD Simona Stefaniga) participated in this group of self-knowledge and 14 patients (for a short peri- od there were 17). Ten of the adolescent participants were hospitalized in Timisoara at the CANP Clinic for attempted suicide (6) or adjustment disorder (4); a psychologist from a college brought in three teens shortly after the start of this approach. The teens were under investigation in a murder trial (they attended only ~ 2 months); 4 teenagers, who were acquaintan- ces of some of those hospitalized, joined the therapy motivated by “curiosity”.

The duration of this model of psychotherapeutic intervention was 18 months between October 2000 and June 2002 with a break during the holidays.

The pace of the sessions was weekly in the first 3 months, weeks, and for the remaining period, it was two times a month. The duration of one meeting was 3 hours.

The assessment of the participants in this group was made at the entry into group: Existence Scale [4], projective tests and interview, which revealed exis- tential and personal difficulties in all participants in the dialogue with oneself and with the surrounding world. The monitoring of the evolution was done with the Assessment Scale of Current Life Situation (A.Langle) at each meeting, and regularly, every 10 meetings and at the end with final thematic essays,diary pages, and plastic representations of the current state.

The aims of this psychotherapeutic endeavour are those formulated by A.Langle for Modules PSY I and PSY II:

– (re)structuring and maturing self–knowledge, (based on F.M. (Comprehension and resentment of F.M. without theory and research) with the aim of personality development;

– exercising the phenomenological vision, in order to look at and discover what is beyond certain distur- bing symptoms;

– becoming aware of one’s own feelings and access to authentic emotionality.

The metaphorical formula proposed to the group for this approach was that of an “assisted trip in the riverbed of their own existence” in order to be able to stop and address those crumbling of the riverbank, eddies or necking, jams, course deviations or falls in cascade from the perspective of Existential Analysis.

The first meeting was structured around the following model:

presentation round – name, surname, the mo- tivation for participation in this group, resources, weaknesses, relationship with parents, how the parti- cipant solved and coped with the problems so far, ex- pectations, fears related to participation in this group.

– establishing rules based on the question: “What would I need in order to participate, and be able to open and develop in this group?” The most common responses were: “We should be listened to!”, “We sho- uld be allowed to dare say what we feel without va- lue judgments, without penalty, with respect to what we feel!” “We should talk just when and for how long we want!” “Let us not monopolize the discussion!”; “Let us be honest!” (AP: “My psychological reality is neither good or bad … it is MINE … what I feel is important, not what others think. They make me offers to help me understand … but I am the one who chooses…“).

– applying the Assessment Scale of the Current

Life Situation. (A. Langle),

final Tour – feedback at the end of this first me- eting.

The second meeting consisted of:

– presentation Tour and my state since the first meeting – (personal forecast bulletin)

– additions, clarifications regarding the expectati- ons, fears, rules.

– plastic Image of my current existential situation:

(“I feel like an alien! I have the feeling that I un- derstand all of them, but no one understands me!”; “On one side There is a swamp, on the other a clearing …but everything is blurry.”; “I feel like a plague from whom everyone keeps away … I feel like punching them!”; “I’m like a clear sky … but uninterested in what is downward.”)

– existential Imagination on the theme “JOUR- NEY”.

– final Tour (how I feel, insights, questions, expec- tations).

Substantive questions that followed the meetings were structured on the following pattern:

– personal forecast bulletin,

– revelations, questions, clarifications on the sub- jects developed anteriorly,

– processing of a self- knowledge topic relating to a particular f. m.,

– subject-related existential imagination,

– my moment- (an acute problem of a participant),

– final tour: revelations, questions, expectations).

The main topics processed in the substantive me- etings were those proposed by A.Langle in PSY II Module:

(I mention that for each theme there are more qu- estions for further study.)

F.M. 1 (I feel I am here! I exist!)

1. How do I “inhabit” my life? (How do I feel, per- ceive my personal space?)

Existential Imagination – theme: Home.

2. Confidence – (consenting to indulge oneself in a structure that gives stability and support to overco- me insecurity). [8]

Existential Imagination – themes: Board and Raft

3. The relationship with my body: How do I live in my body ?; What sense of my body do I have?; Do I feel my body? When? How?

Existential Imagination – themes: Vase and tree

4. Self-knowledge theme – To receive – To take

(In order to be able TO BE, I, You, We)

Existential Imagination – theme: Hiking

Backpack

F.M. 2 (experiencing the fundamental value of life) Do I feel well in my life? Do I like my life? Is it

good (to be here), to exist?

What gives pulse, heat, what makes life pleasant, good … what gives value to my life?

Existential Imagination – theme: Treasure from the bottom of the lakeF.M.3 – BEING YOURSELF

Recognition of the individual in their uniqueness of living, feeling and action:

It is good the way I am? May I stay as I am and how I act? Am I as I really am?

Existential Imagination – theme: The quiet sur- face of a lake

Delimitation of the self:

I and my generation. I and my close entourage. What attracts me, what irritates me? What do I do to be accepted? What can I not do?

Existential Imagination – theme: The Gate

How do I see myself ? Am I aware of what I can do? (Qualities, deficiencies, resources, expectations)

Existential Imagination – theme: The Fountain.

M.F. 4 – Orientation and meaningful shaping of life. Recognizing and accomplishing the value that in a situation we experienced as being in agreement with us.

Existential Imagination – theme: View from the summit of a mountain and Shrine / Place of Worship.

Conclusions:

Experiencing this psychotherapeutic approach was

a positive and stimulating response for the dual chal- lenge that motivated and supported this approach:

For therapists, it was an exercise in “live” and creative participation, a chance of personal revival, a confirmation of motivating assumptions and fulfilling goals for this experiment. In addition, its outcomes were objectified in the results to the scales monitoring the progress, in the final essays and graphic produc- tions, but the participants’ visible changes at attitude – behaviour level were especially noticeable.

For adolescent participants it meant a fulfilment of the expectations that motivated them to come to the group. A visible evolution was also felt and affirmed in the way of relating to themselves and to the world, a calmer, more relaxed and more mature settlement, in the channel of their existence with the feeling that “I entrusted myself to myself.” (A.Langle)

If the rating scales showed with no exception, sig- nificant alteration or even an inversion of polarity, in a positive sense, of the variables concerned, I think that the literary or plastic descriptions of the patients’ state at the end of this psychotherapeutic approach are the most relevant.

K.K. He made these symbolic representations of his mental state at the beginning and at the end of group therapy, accompanying them with a signifi- cant comment:“I was like in a swamp, as if caught in quicksands … the harder I struggled, the deeper I sank! I could not feel myself ! I could not see myself ! Now I could come out … it seems that I have a protective aura which takes me upwards” (Fig. 1 & 2).

During the period of training in existential analysis and logotherapy and later, during the supervision and self-knowledge period, our mentor, MD Wilhelmine Popa and MD Alfried Langle, president of the “In- ternational Society for Logotherapy and Existential Analysis – Vienna” (“Gesellschaft für Logotherapie und Existenzanalyse – Wien (GLE-International)”) who have honoured us by accepting to be included among the founding members of the Society for Existential Analysis and Logotherapy (SEAL) from Romania, founded in 1995 in Lugano, Switzerland and with legal status in Romania, since January 1999, gave us a rich formative and informative material on behalf of G.L.E. Vienna, translated by MD W. Popa and colleagues. They have made these gifts, with the explicit desire that, in our turn, we also should offer them further and help through our work.

This psychotherapeutic approach is an attempt to put into practice their generous proposal.

REFERENCES:

1. Gheorghiu L. G., Salt în moarte pentru viaţă (analiză de caz), pag. 54-59 Revista SAEL 1-2, 2000

2. Frankl V., The Doctor and the Soul, 1986, pag.200-206,

3. Langle A. Poziţia Personală (traducere Dr. Popa W.)

4. Langle A., Orgler C., Existenzanayse nr. 2/iunie 1996, pag. 44-50 (traducere Dr. Popa W.)

5. Popa W., Imaginaţia Existenţială, pag.16-17, Revista SAEL nr.2/1999

6. Langle S., Structura metodologică a Logoterapiei şi Analizei Existenţiale, Buletinul GLE Wien Existenzanalyse 2+3, (traducere Dr. Popa W.)

7. Langle A., Înţelegerea şi terapia psihodinamicii în analiza existenţială, Revista SAEL nr.(4) 1/2005, pag.35-47 (traducere Dr. Popa W. din revista GLE 1/1998, pag. 16-27)

8. Langle A., Omul în căutarea stabilităţii, revista SAEL nr.(4) 1/2005, pag.55-64 (traducere Dr. Popa W., Dr. Furnica C. din Existenzanalyse nr. 2/1996, pag.4-12)

9. Frankl V., The will to meaning, 1988, New York

 

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lorica_gabriela_laura@yahoo.com