کتاب هنر درمان نوشته یالوم در 2001 توسط دكتر سپيده حبيب و دكتر كيومرث فرد ترجمه و در سال 1389 به چاپ رسید.
🔹در مقدمه میخوانیم: …
“کتاب در اصل دارای هشتاد و پنج فصل بود که دو فصل آن به دلایلی حذف شده است…”
🔹دو بخش حذف شده در ترجمه کتاب هنر درمان:
بخش 47- هرگز (تقریباً هرگز) برای مراجع تصمیم نگیرید: Never (Almost Never) Make Decisions for the Patient
بخش 63- از لمس کردن مُراجع نهراسید: Don’t Be Afraid of Touching Your Patient میباشند.
اما چه دلایلی پشت حذف بخش 47 میباشد؟ مگر میتوان برای مراجعین تصمیم گرفت. از نگاه اگزیستانسیال این جمله باید قاب شود و در تمام اتاقهای رواندرمانی به دیوار آویخته شود. تنها قدرت و آزادی که درمانجو دارد همین انتخابهایش است. هر درمانگری که بخواهد این آزادی را از درمانجویش بگیرد به درمانجویش خیانت کرده است و مسئولیت را در او خواهد کشت، مگر اینکه درمانگر محترم خود را یک سوژه دانای کل و دکارتی فرض کند و درمانجو را یک اُبژه تحت مطالعهاش همانند حیوان آزمایشگاهی فرض کند که میتواند برای او هر تصمیمی بگیرد .
از آنجاکه بخشهای 47 و 63 بسیار مهماند، متن اصلی آنها در زیر میآید:
Never (Almost Never) Make Decisions for the Patient
Some years ago, Mike, a thirty-three-year-old physician ,consulted me because of an urgent dilemma: he had a time-sharing condo in the Caribbean and planned to leave on vacation in one month. But there was a problem—a big problem. He had invited two women to accompany him and both had accepted—Darlene, his long-term girlfriend, and Patricia, a sparkling new woman he had met a couple of months before. What should he do? He was paralyzed with anxiety.
He described his relationship with the two women. Darlene, a journalist, had been the high school prom queen whom he had met again at a school reunion a few years ago. He found her beautiful and alluring, and fell in love with her on the spot. Though Mike and Darlene lived in different cities, they’d carried on an intense romance for the past three years, spoke daily on the phone, and spent most weekends and vacations together.
In the last several months, however, the ardor of the relationship had cooled. Mike felt less attracted to Darlene, their s. life languished, their phone conversations seemed desultory. Furthermore, her journalistic duties demanded so much travel that it was often difficult for her to get away for weekends and impossible for her to move closer to him. But Patricia, his new friend, seemed a dream come true: a pediatrician, elegant, wealthy, a half mile away, and most eager to be with him. It seemed like a no-brainer. I reflected back to him his descriptions of the two women, wondering all the while, “What’s the problem?” The decision seemed so obvious— Patricia was so right and Darlene so problematic—and the deadline so looming that I felt the strongest temptation to jump in and tell him to just get on with it and announce his decision, the only reasonable decision, that could possibly be made.
What was the point of delay? Why make things worse for poor Darlene by cruelly and unnecessarily stringing her along? Though I avoided the trap of telling him explicitly what to do, I managed to get my views across to him. We therapists have our little cunning ways—statements such as: “I wonder what blocks you from acting upon the decision you already seem to have made.” (And I wonder, what on earth would therapists do without the device of “I wonder”?). And so in one way or another I did him the great service (in only three fast-paced sessions!) of mobilizing him into writing the inevitable “Dear John” letter to Darlene and sailing off into a glowing Caribbean sunset with Patricia.
But it didn’t glow very long. Over the next several months strange things happened. Though Patricia continued to be a dream woman, Mike grew more uncomfortable at her insistence on closeness and commitment. He disliked her giving him the keys to her apartment and insisting that he reciprocate. And then, when Patricia suggested they live together, Mike balked. In our sessions he began to rhapsodize on how he treasured his space and solitude. Patricia was an extraordinary woman, without flaws. But he felt invaded. He did not want to live with her, or with anyone, and they soon drifted apart.
It was time for Mike to search for another relationship, and one day he showed me an ad he had posted in a computer dating service. It specified particular characteristics of the woman he desired (beauty, loyalty, his approximate age and background) and described the type of relationship he was seeking (an exclusive but separate arrangement in which he and she would maintain their own space, speak often on the phone, and spend weekends and vacations together). “You know what, Doc., ” he said, wistfully, “sure sounds a lot like Darlene .”the moral of this cautionary tale is, beware of leaping in to make decisions for the patient. It is always a bad idea. As this vignette illustrates, not only do we lack a crystal ball, but we work with unreliable data. The information supplied by the patient is not only distorted but is likely to change as time passes or as the relationship with the therapist changes.
Inevitably, new and unexpected factors emerge. If, as was true in this instance, the information the patient presents very strongly supports a specific course of action, then the patient, for any of a number of reasons, is seeking support for a particular decision that may or may not be the wisest course of action.
I have grown particularly skeptical of patients’ accounts of spouses’ culpability. Again and again I’ve had the experience of meeting the spouse and being astounded at the lack of convergence between the person in front of me and the person I have been hearing about for so many months. What generally gets omitted in accounts of marital discord is the patient’s role in the process.
We are far better off relying on more reliable data—data not filtered through the patient’s bias. There are two particularly useful sources of more objective observations: couples’ sessions, where a therapist can view the interaction between partners, and focusing upon the here-and-now therapy relationship, in which therapists can view how patients contribute to their interpersonal relationships.
One caveat: There are times when the evidence of the patient’s being abused by another is so strong—and the need for decisive action so clear—that it is incumbent upon the therapist to bring all possible influence to bear upon certain decisions. I do all that I can to discourage a woman with evidence of physical abuse from returning to a setting in which she is likely to be battered further. Hence the clause “Almost Never” in the title of this section.
Chapter 63– Don’t Be Afraid of Touching Your Patient
At the onset of my psychiatry training at Johns Hopkins, I attended an analytic case conference at which a discussant soundly criticized the young therapist presenting a case because he helped his patient (an elderly woman) put on her overcoat at the end of a session. A long, heated debate followed. Some less judgmental members of the conference agreed that, though it was obvious the therapist had erred, the patient’s advanced age and the raging snowstorm outside lessened the gravity of the offense.
I’ve never forgotten that conference and even now, decades later, a fellow resident with whom I have remained friends and I still joke about the overcoat caper and the inhumane view of therapy it represented. It took years of practice and remedial experiences to undo the damage of such rigid training.
One such remedial experience occurred while I was developing methods of leading support groups for patients with cancer. After my first group had been meeting a few months, a member suggested a different way to end the meeting. She lit a candle, asked us to join hands, then led the group in a guided meditation. I had never held hands with a patient before but in this situation I had no choice. I joined in and immediately felt, like all the members, that it was an inspired way to end our meetings, and for several years we closed each session in this manner. The meditation was calming and restorative but it was the touching of hands that particularly moved me. Artificial boundaries—patient and therapist, the sick and the well, the dying and the living—evaporated as we all felt joined to the others by a common humanity.
I make a point to touch each patient each hour—a handshake, a clasp of the shoulder, usually at the end of the hour as I accompany the patient to the door. If a patient wants to hold my hand longer or wants a hug, I refuse only if there is some compelling reason—for example, concerns about sexual feelings. But, whatever the contact, I make a point to debrief at the next session—perhaps something as simple as: “Mary, our last hour ended differently—you held on to my hand with both of yours for a long time [or “You asked for a hug”]. It seemed to me that you were feeling something strongly. What can you remember of it?” I believe that most therapists have their own secret rules about touching. Decades ago, for example, an elderly, particularly skilled therapist told me that for many years her patients routinely ended the session by kissing her on the cheek.
Do touch. But make sure the touch becomes grist for the interpersonal mill. If a patient is in great despair because of, let us say, a cancer recurrence or any other awful life event and asks during the session to hold my hand or for a hug, I would no sooner refuse than to decline to help an old woman facing a snowstorm put on her overcoat. If I can find no way to ease the pain, I may ask what he/she would like from me that day—to sit in silence, to ask questions and more actively guide the sessions? To move my chair closer? To hold hands? To the best of my ability, I try to respond in a loving, human way, but later, as always, I debrief: I talk about what feelings my actions produced, and I share my feelings as well. If I have a concern that my actions may be interpreted as sexual, then I share those concerns openly and make it clear that, though sexual feelings may be experienced in the therapy relationship and should be expressed and discussed, they will never be acted upon. Nothing takes precedence, I emphasize, over the importance of the patient’s feeling safe in the therapy office and the therapy hour.
I never, of course, press contact. If, for example, a patient leaves in anger, refusing a handshake, I immediately respect that wish for distance. More deeply troubled patients may at times experience powerful and idiosyncratic feelings about touch, and if I am uncertain of those feelings, I make explicit inquiry. “Shall we shake hands as usual today? Or is it best, today, not to?” In all of these instances I invariably examine the incident the following session.
These general points serve as a beacon in therapy. Dilemmas about touch in therapy are not common, but when they occur it is important that therapists not be fettered by legalistic concerns and be able, as the following example demonstrates, to be responsive, responsible, and creative in their work.
A middle-aged woman I had been seeing for a year had lost most of her hair because of radiotherapy for a brain tumor. She was preoccupied by her appearance and often remarked how hideous others would find her without her wig. I asked how she thought I would react. She felt that I, too, would change my views of her and would find her so repellent that I would shrink away from her. I opined that I could not imagine shrinking away from her.
In the weeks following she entertained thoughts of removing her wig in my office, and at one session she announced that the time had come. She gulped and, after asking me to look away, removed her wig and, with the aid of her pocket mirror, arranged her remaining wisps of hair. When I turned my gaze back to her, I had a moment, only a moment, of shock at how she had suddenly aged, but I quickly reconnected with the essence of the lovely person I knew and entertained a fantasy of running my fingers through her wisps of hair. When she asked about my feelings, I shared the fantasy. Her eyes flooded with tears and she reached for the Kleenex. I decided to push further. “Shall we try it?” I asked. “That would be a wonderful thing,” she replied, and so I moved next to her and stroked her hair and scalp. Though the experience lasted for only a few moments, it remained indelible in both of our minds. She survived her cancer and, years later, when she returned because of another issue, she remarked that my touching her scalp had been an epiphany, an immensely affirming action that radically changed her negative image of herself.
A similar testimonial came from a widow who was in such despair that she often came to my office too distressed to speak, but was deeply comforted sheerly by my holding her hand. Much later she remarked that it was a turning point in therapy: it had grounded her and allowed her to feel connected to me. My hand, she said, was ballast preventing her from drifting up and away into despair.
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