Dr. Codrin Stefan Tapu

    

Therapist's Guide

Introduction

According to the hypostatic view of personality, there are four main things

that people do: they think, act (including through words, or verbal

communication), feel, and express through their body language (nonverbal

communication).

Changing the relationships between these four dimensions of doing - both

within the person and in her relationships - is the scope of direct relational

therapy (DRT), just a part of a broader approach to psychotherapy.

Well-adjusted people act what they think, and express what they feel. These

are called direct intrapersonal relations. Also, in a relationship, they think

about others' acts, and feel about what others express. These are called

direct interpersonal relations.

Unadjusted people act what they feel, instead of what they think, or express

what they think, instead of what they feel. These are called crossed

intrapersonal relations. In a relationship, they think about what others

express, or feel about others' acts. These are called crossed interpersonal

relations.


Therapy goals

Improving client's communication and relationships through:

1. Replacing crossed intrapersonal relations with direct intrapersonal relations.

2. Replacing crossed interpersonal relations with direct interpersonal relations.

 

Indications

All kinds of relational problems or discontents, relating to dating, family and

work relationships and/or casual social encounters, anxiety, depression, and

other mental problems. In the case of problems in stable relationships, both

partners should be assessed and participate to sessions, if needed.

 

Conditions treated with DRT

Alcohol and drug abuse and dependence

Anorexia

Attention-Deficit Hyperactivity Disorder

Autism

Bulimia

Conversion disorder

Depression

Dissociative disorder (depersonalization)

Erectile and orgasmic disorders

Impulse control disorders

Mania and hypomania

Obsessive compulsive disorder

Panic attacks

Paraphilias and sexual offenders

Schizophrenia

Sexually abused and post-traumatic stress disorder

Social phobia

Stuttering

 

Client-therapist relationship

During the course of the therapy, both client and therapist should promote

direct relations between each other. This means they should let their feelings

for each other be expressed through their body language, and avoid

verbalizing what they feel about each other. Also, they should freely and

boldly verbalize what they think about one another, and not let their body

language be the mean of communication of thoughts they do not dare utter.

Both client and therapist should try to feel each other's emotions as they are

expressed through their body language, and not let themselves be moved by

each other's actions, and should reflect about the actions of each other, and

not try to discover some meaning in each other's body language. These

relational rules should be made clear by the the therapist in the first sessions,

and the client should be assured that the rules she is requested to follow

will also be closely followed by the therapist.

 

Initial assessment

First, as always, you have to establish what is the main problem that led the

client to your office.

Second, you have to identify crossed relations within the person, and

between her and others. In the preliminary interview, you may want to ask the

client questions like:

 

Tell me if it ever happens to you to act what you feel? For example, to buy

something to the one you love, instead of telling her you love her, or just

letting that show in your gestures and facial expressions?


Tell me if it ever happens to you to express what you think through your body

language, instead of using words? For example, to try to show somebody

through your body language that you do not agree with her, instead of just

saying it to her?


Tell me if it ever happens to you to feel about what others act, instead of

thinking about it? For example, to feel happy about a gift you receive from a

loved one on your birthday, as if it meant that he is loving you too, instead of

maybe just being polite?


Tell me if it ever happens to you to think about what others express, instead

of feeling about it? For example, thinking that if someone frowns, something

is wrong with her or with you, instead of just feeling that she is sad or

angry?

 

Crossed relations questionnaire

Check in the answer you see fit:

1. I decided that's better for me to leave my boyfriend, and

a. I tried to show him that

b. I told him that


2. Today I decided that it's better for me to break up with my girlfriend, and

a. I'll behave so that she will leave me

b. I will tell her that


3. I love my girlfriend, and

a. I always buy her what she wants

b. I'm always gentle with her


4. We love each other;

a. that's why we are moving in together

b. that's why we can't spend much time being apart


5. My girlfriend wants to make up with me, and

a. I'm thrilled about it, 'cause this means that she loves me

b. I agree, because that's better for both of us


6. My partner wants to buy me a house, and therefore

a. I assume he/she loves me

b. I assume he/she wants to make me understand he/she is serious about us


7. I can feel in her eyes that

a. She thinks that I'm smart

b. She likes me


8. He is giving me a bitter look, and

a. I'm wondering what is wrong?

b. I feel that he is angry

 

Answers (a) to questions 1 to 4 indicate that the person is likely to have

crossed intrapersonal relations, whereas answers (a) to questions 5 to 8

indicate that she is likely to have crossed interpersonal relations.

 

Therapy sessions and techniques

The recommended length of a session is one hour, two or three times a week,

for a period of three to six weeks.

In the first two sessions the therapist gathers information about the client

through interviews and questionnaires, like described above.

In the next two sessions the therapist teaches the client how to replace

crossed intrapersonal relations with direct intrapersonal relations, and crossed

interpersonal relations with direct interpersonal relations.

This is made through explaining, exemplifying, questioning, and trying to

change specific relations of the client.

In the next eight to ten sessions the client, helped by the therapist, tries to

change problematic relations in her life.


A session in this part of the therapy has the following steps:

  1. The client presents her crossed relations, as they occurred since the last session;

  2. The therapist asks the client how she thinks the correct relation should sound like, and tells her that, if she could not say;

  3. The therapist, along with the client, tries to identify crossed intrapersonal relations in people with whom the client interacts;

  4. The therapist asks the client about what she thinks she could do to counteract those crossed relations, in order to have good communication relationships with those people, and makes suggestions to her, if she has no ideas.

 

A short fragment of a session:

 

Client: The other day my boss frowned at me, and I wondered what was wrong. I

mean … did I do something wrong or what? I just accomplished all the tasks I

was assigned in the morning. Then I thought maybe he is not feeling well, he

is exhausted and is just upset.

Therapist: But he was just frowning, right? Why is it that this always has to

mean something? But what have you felt that moment? What feelings did

that frowning stir up in you?

C: I think I felt that he was angry . . . . I'm not sure I felt something. But I don't

understand why . . .

T: Maybe there is nothing to understand. Have you ever thought that way? Feelings of

others are meant to be felt, not thought about, right? Can't you just feel his anger

and move on, concentrating your thoughts - and I underline, your thoughts, not your

feelings - on what he is doing and saying? What effect do you think will that have on

you?

C: Maybe you're right. I don't know, I think that would make me less worrisome [he

smiles].

T: Now, the fact that you said you're not sure you felt something makes me think of

something else. How well do you know your boss?

C: Not so well. I started working there just a couple of months ago.

T: Maybe it's a good idea to find out if your boss is the one that is worrisome [the

client laughs].

Maybe by frowning he wants to make you understand that he indeed thinks your work is

not good enough, and frowning in this case expresses no feeling whatsoever. Has this

happened before? I mean, the frowning?

C: Maybe a couple of times, yes.

T: I think you have to try to know him better, to do a little research. See if this

is not something that he does with other employees also. If that's the case, you

have two options: to understand that when he frowns, it's about your work, or to say to

him that when he has something to say, he better say it, instead of frowning [the client

laughs].

Which one do you choose?

C: I don't know, I have to think about it [he smiles].

T: Then you'll have to go with the first [client and therapist laugh].

 

Here the therapist suspected that the client had a crossed interpersonal

relation with his boss, thinking about his emotional expressions instead of

feeling them, but then, when the patient declared that those expressions

were in fact not seeming to really express some feeling or emotion, he

investigated the possibility of a crossed intrapersonal relation on the part of

the boss, who seemed to express his thoughts through body language,

instead of acting them out or telling them.

 

The final assessment

A final assessment through interview and questionnaire is made, to see:

  1. If there are residual crossed relations in the client's life;

  2. If she is able to prevent new crossed relations to occur;

  3. If she is able to counteract crossed relations in others with whom she interacts, in order to maintain good communication relationships with those people;

  4. To what extent the initial problems for which she addressed the therapist have been solved.

 

Treating a typical problem

Patient's complaint:

I want to go to college, but I feel anxious and afraid.”

Defining intrapersonal relations (crossed):

 I want to go to college [thought], but I can't do it [emotional expression]

Tis formulation is not necessarily a thought of the client, but a statement

that - patient and therapist agree - can accurately describe the client's state

at a given moment.

Here we see the individual focusing on his own thoughts and feelings, and not

linking directly the cause - anxiety, with the effect - being unable to go to

college (in fact, the client does not even mention the effect in his formulation

of the problem). 

Feelings of helplessness, and later, hopelessness are generated by the fact

that the individual tries to act according to his feelings, and on his feelings,

but as feelings cannot be changed by voluntary action, he becomes helpless

and thinks nothing can be changed. Also, thoughts not acted out, and not

acted upon, give rise to pathological expressions (symptoms), because only

feelings - and not thoughts - can be really expressed.

The statement above sums up the following words of the client:

When I think of going to college, I have all sorts of strange sensations. I suddenly feel dizzy and I have a kind of weakness in my arms. I can't explain why is that. I really want to go to college, I always wanted to.

I feel anxious and afraid [feeling], and I try to do something about it [action].

Lately I just feel like I'm not myself anymore. I feel anxious and insecure. I was always bold and outspoken, bun now I think I became rather shy. I try to repress these feelings and control myself, but it's useless.

First step: creating direct relations between thoughts and actions, and between feelings and expressions (this is similar to what psychoanalysis calls “insight”, cognitive therapy – “restructuring cognitive schemata”, and person-centered therapy achieving congruence and genuineness). Only this way can the client's thoughts really get in touch with her feelings, and her expressions really support her actions.

I feel anxious and afraid [feeling], and I can't do it [go to college] [emotional expression].

The last two weeks have been like a revelation to me. I figured out what was going on with me. I was anxious about going to college because I felt that leaving my parents and my old friends would be too much for me, and I wasn't sure I could cope with that. And I'm still not. That's why I have these symptoms, the dizziness and all that...

I think I'm also affraid that I could fail in college. I never thought about that before. I always thought that I was a winner. But it seems that now my body tells me otherwise. I don't know if this weakness was always there or if it developed later as I was growing up. . . It's hard for me to admit that sometimes I might be weak, you know. I was not brought up that way... I think that paying attention to this weakness affects me in two ways. On one hand, it's tough to know that you're weak. On the other hand, It's kind of liberating... And, last but not least, it allows you to concentrate on how to deal with your real world problems. Lately I understood that you can get stronger only by dealing with real problems in your life, and not by trying to be strong, or to be fearless, or to be the best.

I want to go to college [thought], and I try to do something about it [action].

Since I'm sure that I really want to go to college, I will try to make sure that I will cope with that. I will periodically talk to my parents and friends back home, and pay visits to them on a regular basis, I mean, I will make a schedule, if necessary...

Second step: the result of direct relations is that problem ceases to exist

I want to go to college [thought], and I try to do something about it [action].

Therefore, I don't feel anxious and afraid [feeling gone], and I can do it [emotional expression gone]. When I'm afraid about it, I express my fears.

Now, that I know and, more importantly, I can really "feel" the cause of my symptoms, and that I devised a way of coping with this major change that will occur in my life, I'm not so anxious anymore, and I think I can do it. If I will ever experience physical discomfort about that, I will know what to do: I will not worry about it, because that's the way I express my normal fears of the unknown that awaits me.

 

Treating anxiety and depression

Relational therapy of mental disorders involves changing both crossed intra- and interpersonal relations within patient's relationships, and crossed intrapersonal relations directly linked with the symptoms of the disorder. The latter are changed through treatment models specific to every disorder.

These are just examples, as for each disorder  there are many possible models, and the patient may exhibit only part of the characteristics described.The models are flexible, as the therapist adapts them to every patient and creates new models if needed in order to respond to patients' demands.

 

Treatment Model for Anxiety

Before therapy: Crossed intrapersonal relations (pathologic)

Scenario: I feel menaced, and I try to avoid the hazardous situations.

Transcript: "I’m afraid of heights, and I try to avoid, for example, being in front of an open window on a high floor of a building, or even crossing a bridge on foot."

Scenario: As there are hazards on the street (in the world), I have panic attacks (symptoms) there.

Transcript: "I think that me having panic attacks in high places is due to the fact that the danger is really there, I’m just exaggerating it. My fear of heights, as bad as it could be, does not explain these strange symptoms that I have, I feel like getting down on the ground, I feel like the void is attracting me like a magnet and I can’t resist the force of gravity. I guess some people do not stand being in a place like this, they have an exaggerated sense of danger. I know that there really is a danger, you can lose your balance if you stay really close to the window, but I think it’s more the way I perceive the situation that the fear itself that paralyzes me like that. I really see a danger where there isn’t one, and that’s making me real sick."

During therapy: Direct intrapersonal relations (recovering)

Scenario: I feel menaced, and I have panic attacks

Transcript: "In the last weeks I realized, talking to you, that I have panic attacks when I’m on a height not because there is a danger there that I perceive disproportionately, but because I feel menaced there, I’m not me anymore when I’m there… now I can clearly see that. The problem are my feelings, not the danger itself. I’m not just exaggerating a danger. The danger is real, of course, when you are in front of an open window you can fall if you stay to close and don’t pay enough attention, you can get sick suddenly and lose your balance, these things can happen, all right. But that’s not the real problem. The real problem is that from all the dangers that there are out there, I single this out as a way to express my insecurity. It’s like a nightmare. I always have wondered why people have nightmares. Now I think I know: because they not feel good about themselves, because they feel that they are in danger, not that there are dangers, if you know what I mean. That’s how I feel, and it happened in dreams to me too, as I told you the last time we’ve met."

Scenario: There are hazards on the street, and I try to avoid the hazardous situations.

Transcript: "Now I think that you really need to pay attention to dangers that you encounter, but that means acting to avoid them not as if you were real scared of the situation, and you avoided it altogether, like staying away from heights, but acting with caution as to avoid real danger. For example, now I try to stay in front of an open window only after I make sure that I cannot fall from where I’m standing."

After therapy: Direct intrapersonal relations (healthy)

Scenario: There are hazards on the street (in the world), and I try avoid the hazardous situations.

Transcript: "Now I can stay in front of an open window, if I make sure that I cannot fall from where I’m standing."

 

Scenario: Therefore, I don't feel menaced, and I don't have panic attacks (symptoms). When I'm afraid, I express my fear (e. g. I'm shaking).

Transcript: "It’s strange, but realizing that [I can stay there if there is not a real danger] makes me feel better even after having a panic attack in front of the open window. It feels like “a good scare”, like watching a thriller movie. You feel kind of liberated when you really get in touch with your fears, you experience them fully and you let them out without worrying too much about that."

 

Treatment Model for Depression

Before therapy: Crossed intrapersonal relations (pathologic)

Scenario: I feel depressed, and I try to do something about it.

Transcript: "I feel depressed, and I’m trying hard to get out of this mood. Last night I tried to throw a party with some old friends, I hoped they could cheer me up. I know that I shouldn’t do that, because I can’t change my mood just by wanting that, but I can’t help trying that over and over again."

Scenario: As the situation is difficult, I cry all the time.

Transcript: "These problems I’m dealing with now are the worst in my entire life. My wife abandoned me for another man, saying that I don’t pay any attention to her needs and feelings. Even if you’re, like, Superman, you can’t help crying out if you end up like me. I can’t do nothing right, I can’t concentrate on my job, all seems useless, and I cry, which I didn’t do since I was a child. And I feel that this crying and not being able to put myself together has little to do with my feelings, I’m generally good at controlling my feelings. No, I think that the situation I’m in is so bad that you can only be paralyzed, no matter how strong you are or how cool you are. It’s not that I loved her so much, but the situation she put me in… I mean… leaving me like that… it’s like a reflex, it even has nothing to do with feelings, I think."

During therapy: Direct intrapersonal relations (recovering)

Scenario: I feel depressed and I cry all the time.

Transcript: "Lately, with your help, I changed the way I feel, but I don’t think it’s necessarily for the better… now I feel like her leaving me really hurt me, and that’s why it’s so difficult for me putting myself together again. When I started feeling that, I suddenly didn’t need to act upon my mood, I rather felt better by just letting it all out. Maybe I was too proud to admit that I really loved her, and that’s why I felt so bad, and that’s why I cried and I couldn’t concentrate on my work, not because she left me and put me in a difficult situation, no, but because I loved her and maybe I felt (and I still feel) guilty about not being a really caring husband."

Scenario: The situation is difficult and I try to do something about it.

Transcript: "Now I concentrate on how I can change the situation I’m in. Because I think this situation, partly created by my inappropriate behavior as a husband, can really be changed. It’s useless to try to change the way I feel, that can be changed either by her coming back to me, or by me letting her out of my life. So now I need to decide what’s better for me, and act accordingly."

After therapy: Direct intrapersonal relations (healthy)

Scenario: The situation is difficult and I try to do something about it.

Transcript: "I tried to get my wife back, we discussed that matter, and I reached the conclusion that I’m not the right husband for her. I can’t give her the amount of love and tenderness that she needs, and we agreed that it’s better for both of us to go our separate ways."

Scenario: Therefore, I don't feel depressed, and I don't cry all the time. When I'm sad, I express my sadness (e. g. weep or cry).

Transcript: "I still love her, and I express freely my feelings of loss, but I’m not so depressed anymore, I think partly because I feel in control of the situation, and partly because I admit and express my feelings, I’m letting all out, you know... now I can concentrate much better on my work and feel that I’m really getting back on my feet."

 

 

Bibliography


1.   Tapu, C.S. . Hypostatic Personality: Psychopathology of Doing and Being Made. Premier, 2001.

 

2.   Personality Theories: Nature Versus Nurture, Positive Disintegration, Two-Factor Models of Personality, Hypostatic Model of Personality, General Books, 2010.

 

3.   Tapu C.S. The Complete Guide To Relational Therapy, CAdPsy, 2011