Phenomenon of tolerance during psychotherapy

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Phenomenon of tolerance during psychotherapy

Kozhuhar G.S.

The article suggests a structural-dynamic model of tolerance in interpersonal intercourse and reveals its main levels and stages. The author's ideas of tolerance in interpersonal intercourse, its formation, development and display are illustratedby the example of the psychotherapeutic relations, described in one of Irvin Yalom's short stories “Fat woman”.

Key words: tolerance, structural-dynamic model of tolerance, level of tolerance, emotional-cognitive discord, reflexivity, critical dialogue.

tolerance psychotherapeutic interpersonal intercourse

Both theorists and practicians of psychotherapy admit the importance of psychotherapeutic relations. In the article the concepts “psychotherapy” and “consultation” are understood as synonyms as it is used the psychological model of psychotherapy in which healthy personality is assisted by psychological means in solving problems and difficulties connected, first of all, with personal growth and development (the comment of the author). Many classics of a foreign and domestic science devoted to this question their special works in which the features of healing relations, the opportunities and difficulties of their creation, the influence on efficiency of therapy results were described. The relations developing between the psychotherapist and his client are understood as one of the main determinants of psychotherapeutic change: aims, beliefs, ways of oneself and world's perception, unconscious experiences and the client's behaviour are subject to change. Proceeding from the idea of the integrity of an inner life it is lawful to assert that the change in any area can generate a «snow-ball» effect and will cause changes in all system as a whole.

Not only the client is changing during psychotherapeutic relations, but also the therapist is. And what internal psychological factors influence the process of psychotherapist's changing? What role does the tolerance shown by the therapist to the client carry out during the construction of healing relations? The article called attention of readers is an attempt to give the answer on these and some other questions.

We have developed a model of tolerance in interpersonal intercourse as well as the scheme of stages of tolerant reaction to the partner in the intercourse. For the purposes of illustration of the model of tolerance we used quotations from well-known psychotherapeutic best-seller by Irvin

Yalom (Ирвин Ялом) «Treatment for love and other psychotherapeutic short stories» (a short story “Fat woman”). The offered model is only one of possible schemes for interpretation of such a complex phenomenon as tolerance.

In spite of the fact that the problem of tolerance became a subject of scientific research not so long ago, various aspects of the problem generated interest of theorists and practicians. In particular, general philosophic problems of tolerance have been considered (J. Bromlei,

R.R. Valitova, V.A. Lectorsky, I.B. Gasanov, M.P. Kapustina, M. Mchedlov, L.V. Skvortsova and others); an attempt of the psychological and pedagogical analysis of the problem has been made (D.V. Zinoviev, P.F. Komogorov, O.B. Skryabina, K. Wane and others). In psychological researches tolerance is considered as an unliability to external influences, adverse factors, that is as a stability (F.B. Gorbov, J.M. Zabrodin and V.V. Golubinov, V.I. Lebedev, E.A. Milerian, E.G. Lukovitskaya, Е. Frenkel-Brunswik, М. Comadena, R.W. Brislin and others). A stability to manipulation and an opposition to influence (E.V. Sidorenko, A.U. Panasiuk, I.B. Sheburakov and others), a psychological stability in destructive and overwhelming situations (G.U. Platonov and others), a frustrational tolerance (G.F. Zaremba, B.A.Vyatkin, K.V. Sudakov and others), a stress-tolerance (А.А. Baranov and others) are studied.

In the context of social psychology it is possible to meet the understanding of tolerance as a tolerance to any differences (ethnic, national, religious, racial, etc.) (D. Brodsky, A. Gerber, E.G. Lukovitskaya, N.V. Moldengauer, V.F. Petrenko and others). The problem of tolerance is analyzed in a context of action aspects of intercourse (V.A. Labunskaya and others), in connection with a search of fundamental conditions of tolerance (T.P. Skripkina and others).

In the context of consultation and psychotherapy the problem of tolerance also becomes more and more actual, especially owing to the increase of a role of differences in the most various spheres of vital activity (P. Pedersen and others).

At the same time, despite of an increased interest of researchers to a problem of tolerance in its most different aspects, there is no common understanding of the given area of problems in psychology up to now; and the system of notions and conceptions hasn't been formed. In the present article, as it was already marked, there is one more attempt of the analysis of a problem of tolerance as one of the conditions providing an efficiency of psychotherapy in particular, and of interpersonal intercourse in the widest sense.

In the reasonings the initial understanding of sense of tolerance included the ideas of tolerance as a stability to conflicts (A.G. Asmolov, 2000) and as a generalized disposition having the wide range of displays (D.A. Leontiev, 2001). Moreover the important preconditions of a structural-dynamic model of tolerance in interpersonal intercourse were some ideas which seemed to us to have been formulated by philosophers the most precisely. First, these are P. King's ideas about the tolerance as a denying of intolerance. At the same time tolerance consists in restraint of hostility in combination with either the postponed negative reaction, or its replacement by more positive reaction. King's definition allows speaking about two levels of tolerance: the first means a delay of the negative reaction; the second assumes readiness for understanding and entering into a dialogue with the person who causes the negative reaction [1]. Second, this is В.А. Lectorsky's idea, according to which tolerance is possible «as a respect for an another's position in combination with an aim at a mutual change of positions (and even in some cases a change of individual and cultural identity) as a result of critical dialogue» [5, p. 54].

In the beginning we offer the description of the model, and then its illustration and the description of stages of tolerant reaction with help of the analysis of psychotherapeutic sessions with Betty (I. Jalom, “Fat woman”, 1997).

The structural-dynamic model includes three basic levels of tolerance's existence and display.

The first level - dispositional - is a level of fundamental basic aims generated on the basis of value-sense system of a person, including the system of relations with the World and other people. The given structuraldynamic formation belongs to stable nuclear layers of an internal psychic life, but at the same time, is opened to a stream of the new information from the external reality.

The second level - reflective - represents a field of direct intrapsychic reactions to the external situation «here and now». This level includes layers both unconscious aims, notions, stereotypes, etc., and the field of understanding and reflective processes.

The third level is characterized by display of behavioural reactions: in fact, this is displaying of the concrete act of a tolerant reaction.

As an important factor of actualization of tolerance we consider a personal maturity which display is the tolerance. The mature personality, besides many important qualities which we are not going to list, is characterized by the high level of reflexivity and the advanced ability to self-determination and self-perfection.

Let's sketchy consider the most important points of the moving of

Yalom's relations and his patient in the context of the problem of tolerance.

It is necessary to emphasize, that since the very first moment of acquaintance with Betty, Yalom feels bright negative to the patient. «Thick women caused disgust in me. I find them loathing… Where have these unworthy feelings come? They are rooted so deeply in the past that it hasn't come to my mind to regard them as prejudices. But if I was asked to answer, I would probably refer to my family, to the thick and imperious women surrounding me in my childhood and among whom my mother was» [5, p. 95-96]. From this description of introspection it is possible to draw a conclusion about the presence of a stable prejudice. The stereotyped negative attitude to fat women, having formed in the early childhood, is also intensified with that standard into which the image of the Woman has transformed during the life. Yalom writes: «I can come out with a suggestion. I was always delighted with a female body - probably, more, than other men. And it did not simply delight me: I ennobled, idealized, and exalted it beyond all reasonable measure. Probably, thick women irritated me with profaning my dream; they were a sneer at fine features which I idolized» (ibid., p. 96). Thus, during perception of an “object” it is categorized and evaluated: the contrast between the standard and reality, discrepancy between expectations and reality arouse disgust, loathing and a number of negative emotions.

Hence, the first stage of display of tolerance in the interpersonal intercourse can be characterized as antagonism in relations (obvious or latent), the basis for which are negative emotions and feelings to the partner, its categorization and evaluation.

As it was already marked, the maturity of a person assumes the advanced ability to display tolerance, because it is included in its dispositional structure as spontaneously (or purposefully) generated during the life. In this sense tolerance appears as a result of deliberate efforts and internal work, overcoming of oneself and one's negative qualities from the point of view of a self-appraisal. Moreover, the adequate reflexivity of a present level of one or another personal features allows to formulate the purpose of self-development precisely. Both personal, and professional maturity assumes not only and not so much existing, “stiffened” structures, but, what is the most important, it assumes an acceptance of the responsibility and an orientation to self-modifications. Yalom writes: «The relation, the relation and once again the relation cures that is my professional motto. I frequently tell students about it. I also tell them about the other things - about how to properly treat a patient: about an unconditional positive estimation, acceptance, sincere interest, empathic understanding» [5, p. 99]. How far these ideal relations are from those negative feelings which Irvin Yalom tries to hide: «Probably, trying to hide my negative feelings, I was too zealous and made a beginner mistake, having started to offer her versions» [ibid., p. 102].

Irvin Yalom, having realized the features of his relation to Betty, pays his attention to the following: «I have always a very serious attitude toward making a therapeutic contract with the patient. When I undertake to treat someone, I assume a liability to support this person: to spend as much time and forces as it will be necessary for improvement of the patient state, and, first of all, to have warmth and sincerity for the patient.

But could I have such things for Betty? To tell the truth she pushed me away. I needed an effort to force myself to look at her face, so much it was covered with fat. Her silly comments were also unpleasant to me… It was difficult to me to imagine a person I would like to chum up with even less. But it was my problem, instead of Betty's problem» [ibid., p. 98-99].

The reflexivity helps Yalom to set himself as a clear and concrete object: «After twenty-five years' practice time to change has come » It is underlined by me (G.S.). [ibid., p. 99]. Thus, in our opinion, the second stage of tolerance consists in a reflexivity of relations' features, and, in particular, in comprehension of a disagreement between carried out categorization and negative emotions towards the patient with that image of a psychotherapist who should be a professional entering into a special sort of interrelations. We have conditionally termed such disagreement as an emotional-cognitive discord because the important element of it is a comparison between I-am-real “here-and-now” and I-am-real, but, at the same time, standard-professional. As a result of it there is a negative self-attitude which, probably, induces to make a purpose of changing. Besides the comprehension of a disagreement in a form of the emotional-cognitive discord initiates an acceptance of the responsibility: «The first step in any therapeutic change is an acceptance of the responsibility» [ibid., p. 102].

So at the second stage of display of tolerance the reflexivity of the emotional-cognitive discord induces to take the responsibility for “denying” of other person upon oneself that entails to make a purpose of changing of oneself.

But in what way is this changing carried out - that is the very work at oneself as a result of which the negative feelings and negative estimations towards the other person are transformed to displays of an unconditional positive estimation, acceptance, a sincere interest, and an empathic understanding?

Answering this question, we use a notion of coping (совладание) for the explanation. In our opinion a tolerant reaction is based on an intrapsychic coping reaction. Nowadays the most popular approach is one which considers coping as a dynamic process, and its specificity is determined not only with a situation, but also with a degree of the personal activity aimed at solving problems which have raised under the collision with a stressful event. Many authors understand a coping as a process of mobilization and management of internal and external resources and their adequate use in a situation (S.K. Nartova-Bochaver, A. Libina, A.V. Libin, N.А. Sirota, V.M. Yaltonsky, J.C. Coyne, R.S Lazarus, S. Folkman, D.J. Terry, A.G. Bikkings and R.H. Moos, L.B. Merphy, A.Moriarity, C.R. Snyder, C.E. Ford, R.N. Harris and others). Yalom asks a question to himself: «What did I want from her? From her point of view, she was very frank. I had to formulate exactly what did not suit me. What in her confessions left me indifferent? I was irritated with her constant confessions in something that was happened in other time and in the other place. Betty was not able or was not ready to reveal herself at the moment we both were present at. From here there were her evasive answers “well” and “okay” that appeared every time I asked her about her feelings here-and-now» [5, p. 105]. This recognition follows a need for an establishment of deep true relations, and an expectation of «the basic meeting» which has a healing influence both upon the client, and upon the psychotherapist. These are those psychotherapeutic relations which change. It is possible to conjecture that the actualization of the need for true relations results, in turn, in a mobilization of internal and external resources which are connected to fundamental value-sense formations of the personality, its system of relations to the World, to other people, to oneself. In this case the basis of such relations is the already mentioned unconditional positive estimation, acceptance, sincere interest, empathic understanding and others. Besides the psychotherapist should be decentralized from his inner life over the inner life of the partner of the intercourse in order to create real dialogical relations. In this instance the decentralization is an integral part of the psychotherapist's professional activity testifying his skill level.

As we have already underlined, fundamental resource of the tolerant reaction, in our opinion, is value-sense system of a person and a system of relations with the world and other people. So the third level of tolerance can be perceived as the mobilization and the control of resources (first of all value-sense system), and also the decentralization from oneself over the inner life of the partner of the intercourse to set up deep interpersonal contact.

There is also the fourth level, which suggests tolerant reactions in behavior.

How does Irvin Yalom solve this problem within the framework of psychotherapy?

Here is how he analyzes the state of boredom that he survives speaking with Betty. “ I have to be accurate and constructive. I asked myself what was boring in Betty, and I found out two obvious features. First she has never told anything personal. Secondly they were her stupid smiles, exaggerated cheerfulness, unwillingness to be really serious. It was difficult to help her to realize all these features without hurting her. I have taken such a strategy: my main premise will consist in the fact that I want to approach her, but her behaviour prevents me.

I thought in this context it would be difficult to be offended with criticism of her behaviour” [5, p. 103-104]. We can formulate several conclusions from this quotation:

First there is a fear to hurt, that is to say to destroy positive relations, secondly nevertheless there is an attempt to show Betty, using critical remarks, particularities of her behaviour, making difficult real contact with her. Thirdly there is a desire to make criticism precise, it means based on facts, and constructive.

Further Yalom continues to analyze causes preventing mutual understanding: “It immediately led to comprehension why Betty seemed me so boring: she played a role before me- in our intercourse she had never been herself, she had always pretended and had defied her exaggerated cheerfulness” [ibid., p.105].

In our interpretation, at the fourth level of tolerant reaction, they use a critical dialogue, with the purpose of real change of behaviour “here and now” through mutual self-disclosure of the partners of the intercourse. Transition to the deep level of communication changes the participants, and the unpleasant, evoking disgust partner becomes an interesting, exceptional interlocutor. There are two quotations testifying the changes that have happened in relations: “There was no need to dismiss the disturbing thoughts about her appearance. Instead of paying attention to her body, I looked into her eyes. Now I noticed in myself with great surprise the first sprouts of empathy [ibid., p.107]; “Now every minute of the session my attention was completely attracted to Betty. Who could imagine, that this woman whose meaningless chatter, that tired me, will turn into an acute, spontaneous and sensitive person?” [5, p.114].

Summing up the above-mentioned, let's underline once again the levels of tolerant reaction during interpersonal intercourse.

The first level of tolerance in the interpersonal intercourse can be characterized by antagonism in relations (obvious or latent) the basis for which are negative emotions and feelings to the partner, its categorization and evaluation.

The second level of display of tolerance is the reflexivity of the emotional-cognitive discord inducing to take the responsibility for “denying” of other person upon oneself that entails to make a purpose of changing oneself.

The third level can be considered as a mobilization and the control of resources (first of all value-sense system), and also the decentralization from oneself over the inner life of the partner of the intercourse. This is only concentration on interrelations, dialogue, discussion; decentralization from oneself over another person can provide real tolerance, facilitating joint development of the partners of the intercourse.

Finally, the fourth level of tolerant reaction consists in different forms of relations. Particularly, it is the form of critical dialogue. In this case critical dialogue assumes the attitude to positive relations, revealing the facts involving difficulties of communication, mutual exchange of remarks.

The aforesaid ideas about the phenomenon of tolerance in interpersonal intercourse (illustrated by the example of psychotherapeutic relations), let us give definition of psychological essence of tolerance of the subject of interpersonal relations as a readiness to perceive another person and establish contacts through the critical dialogue, treat the partner as a interlocutor, as a consequence of overcoming the emotional -cognitive discord.

Besides, according to Bozhovich L.I., the criterion of the personal new formation is its acquisition of motivational force. That's why the premise for statement, that the tolerance has been formed, must be its display as a complicated dynamic system that becomes the motive of the intercourse as a subject activity.

Tolerance shows in the desire of the personality to obtain mutual understanding and co-ordination of motives, attitudes, dispositions, avoiding aggression, suppression of the partner's dignity, but using humanitarian possibilities: dialogue, explanation, cooperation. In this connection, the theme of the dialogue, dialogical thinking acquires the special status in the problematic field of the research of the tolerance. In the opinion of V.A. Lectorsky, as we have already mentioned, the tolerance is possible as a respect for another person's position in combination with an aim at a mutual change of positions as a result of critical dialogue. This is the critical dialogue, as we believe, can be considered as the main way to realize the tolerant position in interpersonal intercourse. The tolerance in the framework of critical dialogue becomes the feature of the openness of the free thinking.

The dialogue and dialogical thinking is one of the essential mechanism of formation and development of real tolerance, and the dialogism turns into the principle of the tolerant thinking.

The literature

1. King P. The problem of tolerance Government and opposition, J.G., № 2., London, School of economics and political science, 1971, pp. 172-207.

2. Lecturing В.А. About tolerance, pluralism and criticism. Questions of Philosophy. 1997. № 11. P. 46-54.

3. On a way to tolerant consciousness / Ed. by A.G. Asmolov. M.: Sense, 2000. - 255 p.

4. Scientific-journalistic magazine «Century of tolerance». М., № 3-4. 2001.

5. Yalom I.D. Treatment for love and other psychotherapeutic short stories. M.: an independent firm "Class", 1997. 288 p.

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