Cultural Expressions Used in the Integrated Psychotherapy Approach: The Sample of Turkish Culture

Asst.Prof. Bahtiyar ERASLAN ÇAPAN  

Ph.D. MD. Tahir ÖZAKKAŞ

From the beginning of the history of psychology to the present day, many theories have been developed to understand human beings, conceptualize and improve their problems. Among these theories, which are quite numerous today, there has been a transition to holistic psychotherapies due to the movement of unification and integration.  

Holistic psychotherapies explain human development as well as the problems they experience in a holistic, relational, cyclical, dynamic and contextual way. Narcissistic personality disorder discussed in this presentation is discussed within the scope of  holistic psychotherapy.

PURPOSE

In this study, the pathology, phenomenology and  psychodynamics of the case exhibiting narcissistic personality patterns that were treated by therapist Dr. Tahir Özakkaş with Holistic Psychotherapy approach within the body of Psychotherapy Institute were investigated and treatment stages were discussed.  The treatment of the case lasted a total of 169 sessions between 2005 and 2012  .   In the course of the case, all sessions were  recorded by video. All session texts have been deciphered.  The data were obtained by examining the transcripts of these study sessions.

In this presentation, the following sections related to the case are focused.

• Conceptual  analysis of the client’s problem

• Evaluation of the psychoticerapia process
• Examinationof cultural factors during psychotherapy 

INFORMATION ABOUT THE CLIENT:

Fikret T. male, 19 years old, maritime college student, single, kiks box sportsman, 1 brother, father is a small fastfodd operator tradesman, mother is a housewife, lives in Gemlık district and has been living in the same neighborhood as a tenant for 19 years. The client’s childhood and adolescence were spent in the same neighborhood. Fikret is ashamed of himself, ashamed of his appearance and voice; anxiety that others constantly look at him and evaluate him negatively; came to therapy with complaints.  Fikret exhibits a diffuse personality pattern. Sometimes he sees his wife as a creature, and sometimes he sees him as the most handsome, powerful person in the world.

PSYCHOTHERAPY PROCESS

• In the process of psychotherapy, the intersubjective space forms the basis of change. The therapist has shown the client an empathetic understanding and has shown features that will meet the needs of the client by acting as a self-object by playing the ideal parent that he can identify with when necessary by mirroring when necessary. 
• In order to understand the dynamics of the client’s problem within the family system, attack therapy was applied in which the family family tree history was taken in detail. 
• In therapy, it is tried to create a whole self by integrating these structures by making the different self structures of the client for identity disorganization noticed. 
• In the behavior of the client due to the lack of superego, interventions that strengthen the observing self are used to strengthen the ego. The client was asked to keep a diary about his behavior and these diaries were read and discussed in therapy.
• Due to the lack of information about the problems of the client, psychotrainings on preoedipal and oedipal period problems were given to understand the dynamics of the problem.
• Hypnotic relaxation study was conducted. Hypnotic relaxation studies were carried out to reduce the client’s negative evaluations and inner voices towards others and to reduce their negative emotions.
• CBT-based interventions were made to reveal the connections of the client’s behaviors with thoughts and feelings that prevent him from behaving naturally. 
• Interviews were conducted with family members to understand the appearance of the client’s development in the family.
• Group therapies were also used. In order to improve Fikret’s interpersonal relationships and self-perception of how he looks in the social environment, he is provided to participate in group therapy once a week in addition to individual therapy sessions. In individual therapy, the group experiences of the client were discussed.
• Assignments are given to create an action plan for what the client can do to establish a connection with reality.
• Dream analysis was performed. 
• Ego states have been studied. Fikret’s ego states, which judge as his inner voice while doing a behavior, saying that he has shit the whole system , have been studied.
• The future dreams of the client were discussed. 
• The therapist tried to understand the client’s problem by using the diaries of the client with a similar problem in order for the client who has insufficient self-expression skills to open himself.

In the study, the following cultural factors were also emphasized in the treatment of the case. 

• When evaluated within the scope of cultural values, it is seen that Fikret has cultural elements in terms of the development of the disease, planning the psychotherapy process, determining the treatment principles, and the elements used in therapy in the case of Fikret showing narcissistic patterns. 
• First of all, it is seen that cultural factors such as the mother’s view as a project child and the father’s lack of mirroring have an effect on the development of the narcissistic patterns of the case. 
• Cultural factors also determine the treatment goals in this case. In Western culture, while the separation of the individual from the family from the age of 19 is emphasized, it has been to support the separation in our country not to open a separate workplace but to work in the family workplace with his father. 
• In the psychotherapy process, more intensive treatment approaches were needed since the clients did not have the luxury of coming to therapy for a long time. For this reason, during the psychotherapy process, 23 sessions of assault treatment were performed in which the client’s experiences with family members were discussed in detail. 
• In the psychotherapy process, anecdotes were used in terms of the use of cultural language and the client’s self-knowledge. 

RESULT

In this study, a psychotherapy process including the elements of Turkish culture with the Holistic Ppsychotherapy approach  of the  case exhibiting narcissistic patterns was discussed. In the conceptualization of the case and in the psychotherapy process, it is seen that the views and techniques of different psychotherapies are used.  In the conceptualization of the case, Kohut, Kernberg and Masterson’s theoretical views on narcissistic personality patterns were used. In addition, in addition to the techniques of these theorists in the psychotherapy process, the views and techniques of the Cognitive-Behaviorist and Inter-Subject Field Theories were used. Most important of all, it is seen that a large number of cultural factors are mentioned in terms of determining the therapy goals and the techniques used in therapy in the psychotherapy process of the case grown up in Turkish culture.