Experiential Psychopathology - Dr John Howells

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IV - Vector Therapy

Illustrations

It may be useful to mention a few clinical applications. Simple and therefore clear illustrations will deliberately be selected so that the principle can stand out. Of course, in practice the situations are often far from simple and make great demands on the skills of the most experienced of psychiatrists.

Situation 1. We have a simple nuclear family of three – a healthy father, a highly neurotic mother, and a disturbed child. The mother and child are locked in an intense, disturbing relationship. Father has been taught by his own family that children should be brought up by mothers. He is concerned, but does not think it right to intervene and moves away to the calm of extra family activities. Vector Therapy can now intervene. The father is brought into an individual interview and he learns that fathers can assist in bringing up children; he unlearns his own family’s rearing practices. Then the nuclear family meets an over a number of interviews comes to accept father as the main parenting agent. The new pattern of vectors brings an immediate improvement in the state of the child. It would still be possible for the disturbed young mother to received psychotherapy; the two therapies are complementary.

Situation 2. A young wife presents with anxiety and depression. Exploration of the family situation reveals that the young couple live close to the paternal grandparents. The paternal grandmother is a hard, harsh, dominating woman. She sweeps into the house everyday and always has something to criticise. The young wife cannot even anticipate at what time of the day her mother-in-law will descend upon the house. Her life is full of tension and expectant anxiety. The birth of her child offers more opportunities for criticism to the mother-in-law.
Over a number of interviews the young couple, and husband in particular, are strengthened to the point when, without precipitating a quarrel with the grandparents, they can move some distance away. The husband is also supported to the point when he makes arrangements for his parents to visit infrequently and at expected times. The young wife’s anxiety and depression lifts. Should the situation dictate it, it would still be possible for the young wife and her mother-in-law to receive psychotherapy.

Situation 3. A 14-year-old adolescent girl presents with aphonia, anxiety and insomnia. Exploration reveals over-protective parents, unable to support their daughter in meeting the normal trials of everyday life. The girl is quarrelling persistently with her schoolmates. Their retaliation depresses her. Her school work suffers. Further family exploration shows daughter looks back with pleasure to a three month period spent with the paternal grandmother, a widow, who apparently shared her pleasure. The girl is transferred to the care of her grandmother with an almost immediate relief in her symptomatology and a marked improvement in her school record. Should it be required the parents and the adolescent could still receive psychotherapy.

Three brief comments must be offered on these examples. Firstly, to say that father must look after his child, that mother-in-law must not visit, and that an adolescent must live with her grandmother is equivalent to a surgeon saying very forcibly “This appendix must come out”. But a child cannot be torn out of his family any more than an appendix can be casually torn out of his body. To make a psychiatric, or a surgical, diagnosis, calls for experience and understanding of pathology, careful assessment (sometimes over a long period of time), the capacity to evaluate the essentials of a mass of data, the ability to formulate clear advice, an empathic relationship that dissolves the fears of the patient, and sometimes the patience to wait until the patient is secure enough to adopt the remedy that will bring relief. Vector Therapy is an exacting psychotherapeutic procedure. It may call for brave decision-making and sensitive management of the patient, his family, and the many agencies that can assist in the re-patterning of the vectors.

Secondly, in each of the examples given, interview psychotherapy could also be of assistance.

Thus, Vector Therapy and interview psychotherapy are complementary. Indeed, the best results are obtained when they are employed together.

Thirdly, the change takes place not in the pattern of physical forces inside and outside the family, but in the pattern of psychic emotional forces.

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