Abstract
EH, a 25-year-old single woman, came to the University of Tehran Clinic complaining about fear of death. Fear of death had started in her about ten years ago, when she was fifteen. It had become worse and had disrupted the normal course of her life since a month ago when her grandmother passed away: “For a month now, I’ve been feeling I’m about to die. This happens especially at nights. If I remain motionless for a minute, I feel that it’s the end of me. I have to move my arms and legs so I can feel alive. Otherwise I die.”
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Notes
- 1.
In the PTC model of treatment before prescribing therapeutic techniques, the therapist needs to clarify some possible interventional experiences which the patient might have had beforehand. What has the patient done so far based on his/her own managements to solve the problem? Whether the patient has already received any professional help/treatment or not? The first reason for doing such probes is that the therapist must be aware of the patient's past interventional experiences. The second reason is that whether and to what extent these experiences have been useful according to the patient. And the third reason is that if the patient is receiving any other psychological and/or medical help? Leaving out all these arrangements and interventions before starting PTC and during the treatment is necessarily instructed to the patient.
- 2.
The PTC psychotherapy benefits both the foundations of systems theory and systemic techniques a lot. This book, as a basic practical guide for clinicians, however, is just limited to discuss the basic techniques of the PTC model. The systemic techniques of the PTC model can be seen in PTC perfect model of therapy with couples: A practical guide (Besharat 2018).
- 3.
Both theoretical and empirical considerations of the PTC model require that a patient should not refer to different specialists simultaneously. Except in rare conditions, as a general principle of PTC, the patient should not be under any medication for the presenting disorder.
- 4.
When prescribing tasks, the PTC treatment does not impose anything on the patient. All the tasks prescribed for the patients are exactly the same symptoms that the patient is experiencing in his/her daily life inevitably. This is the main reason that makes paradoxical timetable the easiest task in terms of the patient ability to do it.
- 5.
When describing their changes, the patients either refer to their ability to control the disorder or express new description of their symptoms completely different from the previous ones. For instance, “They were just like a feeling. They no longer had the horror of death with them”, in the present case; “I felt like my head was getting cold, but it was over so soon and I felt no palpitations or difficult breathing or anything” in the patient #9 at session 4; “Slight thoughts just come and go, and I know they are nothing serious” in the patient #13 at session 8; “It’s just like a wind which blows and goes away” in the patient #14 session 4; “They come and immediately go. They no longer stick in my mind to torture me” in the patient #18 at session 5; and “They come and go like shadows” in the patient #19 at session 4. Considering such descriptions give us a better understanding of the effective mechanisms of the paradoxical timetable.
- 6.
The process of increasing number of tasks, which refer to as increasing dosage in the PTC model, can be seen in explanation presented under the patient #12.
- 7.
Some points concerning why and how to cease medication are worth noting here. One of the principles of the PTC therapy is that the patient mustn’t receive any treatment simultaneously, except in some especial conditions. So, any other intervention must be ceased. Within the broad spectrum of the anxiety disorders including OCD and related disorders, drug therapy has nothing more than sedative role. This is why the patients are interested and completely ready to cease medications not only because of their negative side effects, but also they are not curing. The process of ceasing medications would be different from one patient to another. The therapist warned the present patient at the first session that the medication must be ceased to make her ready for that. She then reduced her medications up to 70 percent in the interval between the first and the second session. Continuing the PTC tasks helped her to cease her medications completely by the third session! There was no need for the therapist to demand the patient to stop medications in the present case. The patient #3 presented by a different story. She had taken antidepressant medications for more than 10 years when started PTC. She had had the experience of ceasing/forgetting her medication for several times. The therapist suggested that she can do the exact way of ceasing the medications once more in the interval between the first and the second sessions while doing the assigned PTC tasks. What happened to the patient #3 in this regard supports the exclusive power of the PTC psychotherapy.
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Besharat, M.A. (2023). Client #2 (Female, 25 years Old, Single). In: Paradoxical Psychotherapy: A Practitioner’s Guide. University of Tehran Science and Humanities Series. Springer, Cham. https://doi.org/10.1007/978-3-031-27717-7_3
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DOI: https://doi.org/10.1007/978-3-031-27717-7_3
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