Red Sistémica · Psychopathology
The world of fears (part 2). The use of prescriptions in phobic and panic disorders
Continuation of the article published in no. 85 of Perspectivas Sistémicas. Having described the failed effects of a paradoxical prescription, Marcelo Rodríguez Ceberio distinguishes three results that can be considered favourable. This fragment, republished by Red Sistémica, develops the first of them: the patient has tried to make the symptom appear and has not succeeded.
Editor’s note
Red Sistémica republishes this text under the heading “Fragment”. It follows on from the first part, which breaks off precisely on the sentence that opens this one.
“The domino effect is no longer directed towards chaos, but towards evolution and growth.”
Marcelo Rodríguez Ceberio
Three favourable results
Three results can be considered favourable:
a
The symptom does not appear
The patient tried to stimulate the appearance of the symptom and did not manage to make it appear.
b
The symptom appears in full
The symptom made its appearance in full, quantitatively and qualitatively.
c
The symptom appears in part
The symptom appeared partially, with an intensity varying in percentage.
First case: the patient could not reproduce his symptoms
In the first hypothesis, the patient managed to carry out the task but, to his great surprise, he tried and tried again without being able to reproduce his symptoms. It is the first time, after months or years, that he has faced the symptomatic monster that dominates him, and he did not give way before its threats of appearing. This obliges him to leave an asymmetrical position that places him below, looking at the symptom as if it were a giant. He has begun to feel more sure of himself. After so long, it seems strange to him not to experience the sensation that has accompanied him so much. The therapist will positively connote his actions but, appearing sceptical and as if thinking aloud, will urge him to do the task again:
Relaunching the prescription
Hmm…, how strange that you didn’t manage to set off the symptoms…, odd! Since they’ve always appeared spontaneously, now that they have to be done on purpose, they don’t come… Let’s see, let’s try again…, let’s do the exercise again, but this time you’ll get closer to the lift. Try at 2 metres…, but you could add the sweating, on top of the stomach and throat pains…
If, once the new prescription has been carried out, the result is the same (that is, he has not managed to unfold the symptoms), the patient probably begins to feel that the symptom is dominated by him, which places him in the upper position in the interaction with it, whereas it had always been the other way round. It is then plausible that, in this process, his security and his sense of personal worth increase (characteristics lost when one is at the mercy of the symptom), and that he gradually feels more independent. In other words, the domino effect is no longer directed towards chaos, but towards evolution and growth.
The externalisation of the symptom (Michael White, 1992), to which we alluded above, implies that with the figure of the monster dominating the patient a hand-to-hand struggle develops. This key makes it possible to give a body to an adversary that, until then, appeared as abstract. In this way, it becomes possible to engage the symptom in a fencing bout in which the prescriptions are the various manoeuvres that make it possible to outwit the function of the symptom.
Key takeaway
When the patient cannot manage to produce his symptom voluntarily, the therapist does not gloat: he connotes positively, appears sceptical and relaunches the task, making it harder. It is the repetition of this failure to make the fear appear that places the patient in the upper position in relation to the “monster”.
The second possibility is…
Editor’s note
The complete text can be read in Perspectivas Sistémicas no. 86, at newsstands, in bookshops or by subscription.
Who is Marcelo Rodríguez Ceberio
Dr Ceberio is a psychologist, director of the psychology programme at Maimónides University, national and international trainer in systemic family therapy, author of numerous articles and books, co-director of the ESA (Escuela Sistémica Argentina) and associate editor of Perspectivas Sistémicas.
This article is an English translation of “El Mundo de los Miedos (2° Parte). Uso de prescripciones en los trastornos fóbicos y de pánico”, published by Red Sistémica (first published in Perspectivas Sistémicas, n° 86, mai-juin 2005). Translated and republished with the journal’s permission.
Read the original articleHow to cite this article
Rodríguez Ceberio, M. (2022). The world of fears (part 2). The use of prescriptions in phobic and panic disorders (Complexe Systémique, Trans.). Complexe Systémique. https://app.complexe-systemique.com/en_GB/articles/the-world-of-fears-part-2-the-use-of-prescriptions-in-phobic-and-panic-disorders (Original work published in 2005 in Perspectivas Sistémicas, n° 86, mai-juin 2005; republished in 2022 by Red Sistémica, https://redsistemica.ar/2022/07/19/el-mundo-de-los-miedos-2-parte-uso-de-prescripciones-en-los-trastornos-fobicos-y-de-panico/)
To go further
- The paradoxical prescription of the symptom: a counter-intuitive strategy for changeThe foundations of the intervention Ceberio applies to fears: prescribing the symptom in order to outwit it.
- Externalizing the problem in therapyMichael White’s manoeuvre, which the author mobilises to engage in a “fencing bout” with the symptom.
- The MRI (Mental Research Institute): the legacy of Don Jackson. Interview with Wendel RayThe Palo Alto school whose brief therapy inspires Ceberio’s treatment model.
- The world of fears (part 1). The use of prescriptions in phobic and panic disordersThe first part of the article.
Related training courses
Symposium
The Abnormal Normals and the Normal Abnormals
Conference replay: six clinicians explore normality — diagnoses, norms, adolescents, therapists. Immediate, lifetime access. Talks in French.
Online course
Master the art of narrative therapy: a unique journey with Charlie Crettenand
Immersive online course: discover the narrative approach with Charlie Crettenand. A unique audiovisual journey, lifetime access, exercises. In French.
Comments 0
Log in to join the discussion. Log in