Читать книгу Well-Being Therapy - G.A. Fava - Страница 17

When he came back, he had his diary. He had written a few instances of well-being. He reluctantly acknowledged that they were present, but added ‘they were extremely short, a few minutes only’. Table 1 illustrates one of these instances. I was surprised to see that, even in the midst of distress and suffering, there were some good times, although they were brief. Tom was then instructed to report also which thoughts led to a premature interruption of these instances of well-being. Again I did not share with him information about the type of thoughts we were looking for (automatic thoughts) and the potential explanations that could be made. I wanted him to develop his own antidote.

I did, however, write down in his diary a few things (I always write in the diaries of my patients: instructions for taking medications, behavioral assignments, things we discussed in the session that I feel important). I asked him to go back to the university every other day and to select one exam to be taken. He complained, ‘It makes no sense. I am no longer able to study.’ I replied that gradually we would have come back to it, and I shared with him the story of when I broke my leg while skiing at the age of 11. It was a bad fracture and the orthopedic surgeon applied a cast. I had to keep it for three and a half months, without ever standing up. Finally the day came when my cast had to be taken off, and I thought my agony would be over. My parents did not tell me anything; I thought that my bone had been fixed and I could get up and run. When the surgeon removed the cast, I discovered it was not true at all: my leg had no muscle, I could not bend the knee and when I tried to stand up I realized I was not able to. I started crying, saying that my life was ruined and that I could no longer walk. I do not know whether the clinical choice of the surgeon had been the best also in those days, but his response was:

Table 1. Second session

Situation	Feeling of well-being	Intensity (0-100)
Late afternoon.I am at home studying.Laura will be coming soon.	I am happy to see her.	40

Do not cry, Giovanni. It is the way it should be. Now you should start doing some exercise [he just gave me a couple of hints; there was no physical therapy in the place where I lived]. But remember: some days you will feel that you are making progress, that you can bend your knee a little more than the previous days. Other days, you will feel that it is getting worse, that you bend your knee less. Do not worry. Keep on doing what I told you. You will run again.

This is what happened and I often share this story with patients. Therapist self-disclosure was found in psychotherapy research to lower patient distress [5], and I have always felt that it is important for a physician to transmit both technical and emotional knowledge.