Beyond the diagnosis
The Acompanya'm Educational Therapeutic Unit , where I have worked as a clinical psychologist since June 2018, is a residential resource of the therapeutic community type for minors with serious mental health problems linked to high family and social complexity.
Most of the girls and boys who come to us have a long history of suffering that they have managed to cope with as best they could.
They are, in a way, veterans of mental health services, they have pivoted through both outpatient and hospital resources of the network, they have received a multitude of pharmacological treatments, and they generally come loaded with diagnoses with which they present themselves (or against which they rebel) and which cover our need, as professionals, to give a name and attribute an origin to what we are seeing, even if we do not fully understand it.
In Cristina's case, one of the protagonists of #YoCambioTodo , she had been diagnosed with autism spectrum disorder, anxiety, and depression, but previously with attention deficit hyperactivity disorder (ADHD) and even bipolar disorder. And yet she complained of never feeling heard, neither in her family nor in the healthcare system later on.
Cristina Rubio
A diagnostic label can prevent us from seeing the complexity of the whole picture, and therefore from adapting to the most basic needs. Classification is necessary; we need to name things to stop being afraid of them. The problem is confusing the name with what it really is, as they say in systemic therapy: the map is not the territory.
Hyman (2010) has called this the "reification" of diagnosis: believing that the name we give it explains everything about a phenomenon or is the phenomenon itself. To presuppose that a phenomenon like psychological suffering can be understood from a single perspective is reductionist; it transforms complexity into a list of symptoms, leaving out the importance of context, the person's subjectivity, the often highly traumatic experiences they have lived through, and, with the best of intentions, exacerbating the experience of loneliness.
Symptoms arise within a family and social context from which they are inextricably linked. Therefore, institutional intervention must be directed not only at the individual, but also at their family and social context, working to repair ties with the community and promote its inclusivity.
The girls and boys we see often come from non-protective family and social environments where they have been exposed to early trauma. Repeated trauma disrupts the functioning of the mind, leading to stress response disorders, attachment problems, attention difficulties, learning difficulties, behavioral problems, and socialization difficulties, among other issues.
Furthermore, public policies and institutional conditions often fail to adapt to the needs of children, creating a new context of vulnerability and neglect, this time on the part of the system.
To provide a protective and safe environment
That is why the first priority before any other intervention is to offer a protective and safe environment . Protective in terms of practices, but also safe in terms of emotional availability and support, unconditional acceptance, absence of judgment, and genuine listening.
This allows for the stabilization of daily routines in the life of the child or adolescent, and through a tuned relationship with the professional (therapist, educator…) to promote self-observation, mentalization and emotional regulation, essential tools for the development of resilience.
The therapeutic proposal therefore presents a broader perspective, which places the focus of treatment, beyond the disease and the symptoms, on lived experiences, the development of a biographical narrative, and the social, biological, historical-cultural and intergenerational determinants.
In this way, therapy becomes a shared construction in which subjectivity, bonds and resilience take center stage, with the aim of helping to rebuild an exciting future project full of new opportunities.
Photography: Carles Salillas/OHSJD Aragó
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