Four elemental questions for therapeutic psychology: a personal view

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In this article, David Zigmond, who is a GP, Psychiatrist and psychotherapist, gives us four fundamental questions to ponder when we see patients for psychotherapy. Zigmond is concerned that the medical model, prevalent in the NHS, does not equip us with the mindset that is necessary for an authentic encounter.

He proposes four fundamental questions for therapists, which “escape subsumption to prepackaged, designatory psychologies”, and are, in his experience, “primal to any likely successful engagement”.

1. What is it like to be this person, to have lived their life?
2. What is the meaning and experience, for them, of this kind of distress?
3. What is the meaning and experience, for them, of me, now?
4. What do I need to understand of their needs that theyvpossibly cannot yet express, or even think about?

Zigmond describes these questions as “naive”, in that they assume very little. Indeed, by asking ourselves these questions as practitioners we are necessarily led to discard accepted theories and conventional perceptions so that we can form an understanding of the person’s presenting needs based on our experience of them, of ourselves as we are in relationship with them, with empathy, curiosity and openness.

The term “naive” is quite important here and I find myself drawn to it. As a psychotherapist and counsellor in London I have, like my colleagues, undergone years of therapy, supervison and training, and I know still that my learning has only begun. Psychotherapist D.W. Winnicott prefaced his book “playing and reality” with the following words: “to my patients, who have paid to teach me”.

It is tempting for many to adopt a top-down approach to psychotherapy for depression, relationship problems or problems such as anxiety. By this, I mean that the practitioner concerns themselves with acquiring an understanding of the symptoms that each condition presents and developing an approach whereby they can track progress in treatment according to criteria of functioning that may have nothing to do with the person, but that are instead taken from a group-level view.

While the latter approach is necessary in driving some areas of research and monitoring outcomes in institutional settings, the former needs adopting in every encounter. By doing this, the practitioner has the better chance of not only fulfilling their role in an institution, but also to meet the person who is suffering as an equal and give them a chance to be understood more fully and more immediately.

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