Molnos, A. (1998): A psychotherapist's harvest


The patient's way of presenting his problem as a series of symptoms and/or a flaw in his personality is often his unconscious first line of defence against a deeper inquiry. The therapist must not be put off by it. Instead she has to bear in her mind the question: "Why now?" and investigate the nature and details of the precipitating event or events.

The therapist has to be fully aware of the fact that seeking therapy is not a random occurrence. She has to examine the hypothesis that there is a specific precipitating event. The reason a person seeks therapy at a certain time nearly always can be explained in terms of an emotionally loaded precipitating event. It might be the death of a friend or relative, or having to face the prospect of his own mortality. Births and marriages, a job change, having to move house, significant anniversaries or birthday or even the anticipation of such events, may stir up strong feelings and induce the person to take stock of his life, to desire change, and perhaps seek help. Of course, the same precipitating events have different meanings for different patients.

A precipitating event is invariably linked to a relationship and/or to the patient's own stage of development and/or to the ultimate question of life's meaning ¾ or to all three at once. These are the areas Budman & Gurman (1988, p.36) call the developmental, the interpersonal, and the existential aspects. Although the precipitating conjunction of events occurs in the patient's current circumstances, his emotional reactions to it come from the past which will then have to be investigated and worked through as well. Thus, the precipitating events are the key to the patient's troubles and his motivation for therapy.

Ideally, establishing the precipitating event and understanding its real meaning for the patient should mark the start of the beginning phase of therapy.

See also index: PRESENTING PROBLEM, RELATIONSHIPS. The next pathfinder entry is (9) BEGINNING PHASE.