The relationship is what the clinical psychology intervention works on and aims at.
Clinical psychology can be defined as the psychology of relationships.
Many agree with these statements, which have already been examined in some of the articles in this Rivista di Psicologia Clinica.
We believe that a great deal of work needs to be done to thoroughly understand the idea of clinical psychology as the psychology of relationships.

1 – First example

During the lectures in my first university course in Clinical Psychology, I present the two original branches of psychology: behaviourism on the one hand, and gestalt on the other. One of the observations I make concerning this is about the way data is collected in classical experimentations in the two approaches. I underline that behaviourist experiments set out to observe and measure “objective” data, in a strictly empirical perspective.  If one can measure the stimulus with the CGS system (centimetre, gram, second) and make some kind of measurement of the behavioural response, one can use numerical data in ordinal and interval scales. In contrast, in the gestalt area, one often relies on what the experimental “subject” reports, one records subjective evaluations and responses, and therefore one gets data that must be read and elaborated only within the relationship with the experimenter. This statement is usually difficult for second year university students to process.
To make it easier to understand my theoretical proposals, I give examples of behaviourist experiments and gestalt experiments. In the last lecture, talking about gestalt experimentation, I put the following figure on the blackboard:

I then asked what the students “saw” in what I had drawn. A female student said: “three columns”; another student said “three roads”, therefore many of them highlight a sense in what they are presented with by dividing the drawing into three elements  and giving it an “object-like” meaning. A female student raises her hand and giving me a defiant, ironic look, says: “six lines”. In the lecture room a lot of people laugh. This student seems to have understood what I was suggesting, that is, the validity of the principle of proximity that “forces” one to put together the lines that are close, configuring them in a gestalt with meaning (columns, roads…); she is irritated and angry (her words, in recognising her own emotions during the analysis of the experience) at this sort of “manipulation” by the teacher; she therefore thinks that the only way to repudiate what the teacher “forces them to see” is by taking the drawing apart, thus giving a “literal” answer. The event as a whole, in short, can be understood if one has models for interpreting the relationship, the context in which the relationship occurs: this enables one to understand that a response depending on the subject’s self-observation, in an experimental situation, acquires sense only if it is part of a relationship underlying the experimental situation itself. In our case the smart young student gave precedence to the emotions aroused in her by the teacher’s experiment, and she reorganised the situation so as to make it both critical and amusing.

2 – Second example

A psychologist, recently graduated, participated in a support project in a primary school in Central Italy.  She was asked to work with a support teacher1 in a first class in primary school, giving psychological consultancy. In the first meeting with the psychologist, the two teachers, class teacher2 and support teacher, presented her with a problem. The class teacher tells of a mother, aggressive and problematic, and her “disabled” daughter; the mother expects her daughter to be actually integrated into the class, and therefore not entrusted just to the support teacher, and that she will keep up with the other, normally abled, children in learning3. The teacher recalled that to deal with this mother, it was often necessary to raise your voice.
She then asked the psychologist if she could confirm some of her suspicions about the girl who, in her opinion, could not tell one colour from another4; when the girl was asked the colour of something or of one of the pictures in the book, she always answered “blue”. The support teacher agreed with the class teacher’s impression. What did our psychologist do? In little more than half an hour, she approached the child, showed her some coloured pages and kindly asked her to say the colours in the pictures, ascertaining that the girl recognised the colours. She was then able to answer the two teachers’ question: the child was able to distinguish colours. The class teacher reacted tartly: the pupil must have learnt to say the colours recently, in the last week.
This is a situation where, in her role as consultant, the psychologist does not seem to take into account the relationship involved in the consultancy. The problem presented to the psychologist seems to concern, if seen from outside the relationship, a single individual and her individual features: a presumed deficit in colour vision. The deficit seems to be “achromatopsia”, usually genetic: a disorder that can hardly be ignored, at least by the mother, for all the seven years of the child’s life. The psychologist’s behaviour aimed to answer the teachers’ question, with no attention to the (relational) nature of the question asked of her. The class teacher, on the other hand, spoke aggressively about the mother; the mother “actually expected” the daughter’s integration in the class and did not seem willing to accept her daughter’s learning limits. The psychologist might ask herself why the “differently abled” child should give those stereotyped, repetitive answers to the teacher’s questions about colours, while with the kindness and affection of the relationship with herself, the girl could recognise and correctly name the colours. It might occur to her that the colour blindness is the handicap sought, to add to the girl’s emotional instability, in order to open the mother’s eyes about her daughter’s learning potential. In other words, the psychologist might ask herself about the relationship between the two teachers and the girl, in connection with the relationship between the teachers and the mother.  She could also make sure her consultancy facilitates the two teachers in questioning themselves about their difficult relationship with the child’s mother, and therefore with the slow-learning pupil.
The relationship between the two teachers and the psychologist must also be taken into consideration, as well as the relationship of the two teachers with each other. The request addressed to the psychologist can be considered a way of using her as a tool to confirm the child’s disability. It was therefore intended to oppose the mother’s request by bringing her face to face with the various disorders shown by the daughter in class,  to which to add an incapacity to recognise and name colours. One can also consider how important colour recognition is, for the two teachers, in working on the first stages of primary learning, that is, “reading writing and doing sums”.
It was the class teacher who suspects the girl’s probable colour blindness. The mother asks for an integration of class teaching and support teaching. Usually this integration has little hope of success, and the psychologist should be well acquainted with the situation. There is the tendency to delegate the care of the slow learning pupils to the support teacher, so as to allow the class teacher to work “normally” with the “normal” pupils. The mother seems to want to bring this split into question, and asks for integration in opposition to splitting the support role from the role of the class teacher. It could be in the class teacher’s interests to underline the girl’s problems; how can the girl be taught in a normal learning rhythm when she can’t even distinguish colours?

3 – Third example

A third example, taken from the book “La felicità” (Happiness), by Paolo Legrenzi (1998)5: this is an experimental situation that the author proposes to the reader. The topic of the experiment, which we do not want to analyse in detail but only to comment on, concerns the “endowment effect” theorized by Richard Thaler, later taken up by Daniel Kahneman and by his group6.

“Here are the instructions that the game leader must follow.
Once the participants have been divided into two groups, one of the groups is given the name“salespeople”. Each member of this group is given, for instance, a cup. Explain that the cup is theirs, they can keep it; they are then asked how much money they want to return the cup to the leader. In other words, at what price they would agree to sell the cup.
The second group, the valuers, are asked, unbeknown to the other group, to say how much they would be willing to pay to have the same object that was given to the salespeople.
Each person in the two groups has to write the figure on a piece of paper without showing it to anyone else. It is also explained that once the figure has been written down, the real market price will be revealed. This is the price paid by the leader to buy the cup, before the game.
After the estimates are made, the prices written on the pieces of paper are shown. If a member of the salespeople wrote a lower price than the real price, the purchase price, then s/he keeps the cup. If a member of the valuers wrote a price below the real price, s/he gets the cup free. If the figure written down is higher than the real price, both the salesperson and the valuer  finish the game with a sum corresponding to the real price. The salesperson gives the cup back to the leader and obtains the money, while the valuer obtains the same sum directly.
This description seems a little complicated. Actually both the salespeople and the valuers are faced with the same simple choice: finishing the game with a certain sum of money or with the cup. Note that it is not plausible to think that the cup has acquired a sentimental value for the salespeople7. In fact it was given to them at the beginning of the game. They have just obtained it, as if they had won the lottery, but without even deserving the win.
From the objective point of view, the game made only one difference between salespeople and valuers.  The former owned the cup, even though for a very short time. Will this very short time of ownership be enough to differentiate the behaviour of the two groups of people?
Try counting the number of players who at the end of the game decide to keep the cup: you will see that there are always far more from the salespeople's group. Try calculating the average of the prices written on the pieces of paper: you will see that the average price written by the salespeople is always higher than that written by the valuers.
We are dealing here with a pure cognitive mechanism8: the fact that an object is mine, even though I am not yet fond of it, makes its value increase in my eyes. From the point of view of an economist or an expert businessman all the players are in the same position. One must simply establish how much a given object is worth.
From the psychological point of view, things are very different for the members of the two groups. The valuers, in fact, have to decide the minimum sum of money they are willing to give up to get the cup .The salespeople, on the other hand, already have the cup. They have to decide whether to get rid of it in exchange for a certain sum of money, which they themselves must set. The cup has already been “incorporated” into their property. The different forms of behaviour indicate that the displeasure at losing something that is ours is greater than the pleasure of buying it. The measurement of this displeasure is, precisely, the average difference of the sums indicated in the two groups” (p. 24-25).

As we said, we do not want to give an evaluation of the experiment described; we will comment on the author’s description of the experiment, and we also invite you to look carefully at the psychological considerations the the author draws from his description.
A cup is “given” to a group of people. Immediately afterwards, the “giver” asks them to sell him the cup back. Doesn’t it seem to be a rather strange relationship? The author says it is a “pure cognitive mechanism”: he is talking about the fact that the gift enabled the experimental subject to “own” the object, and this makes the value of the object go up in his eyes. But is it ownership (a seemingly individualistic phenomenon) or relationship; a strange relationship, loaded with symbolic-emotional meanings, in which a person “gives” you an object and straight away asks you to return it in exchange for payment? I remember that in my childhood games, on this point we recited a threatening rhyme:  “something given and taken back, go to Hell alas alack”. This rhyme served to exorcise that childish fickleness that leads a child to give his/her best friend an important object, only to ask for it back due to regret or to a sudden conflict. When experimental situations are set up in psychology, one asks what type of relationship the experimenter wants to activate. One asks if the result that we obtain is linked to the phenomenon we are trying to test, or to the relationship we establish to make it possible for the phenomenon to take place in a laboratory setting. More in general, we wonder can experimental psychology ignore clinical psychology and its relational component?

References

Legrenzi, P. (1998). La felicità [Happiness]. Bologna: Il Mulino.

Notes

* Full Professor of Clinical Psychology in the the Faculty of Psychology 1 at “La Sapienza” University in Rome, President of the degree course “Clinical intervention for the person, the group and the institutions”, full member of the Italian Psychoanalytic Society and of the International Psychoanalytical Association. Top

1. The support teacher in the school helps pupils with learning difficulties linked to physical, sensorial, cognitive or behavioural problems. In particular s/he works alongside the pupils during class activities so as to enable and facilitate the scholastic integration of differently abled pupils.
The support teacher has a university specialization; s/he is assigned, on equal merit with the other teachers, to the class comprising a differently abled pupil with the purpose of implementing forms of integration in favour of such pupils and of carrying out individualized learning interventions according to the needs of the single pupils. Top

2. ‘Class teacher’ refers to the teacher responsible for the learning of the whole class, in which the differently abled pupils present are under the care of the support teacher for the implementation of specific learning and socialization programmes. The two teachers (class and support) have to cooperate to achieve integration. Top

3. The mother’s request, when looked at closely, is fully consistent with the aim of the law on integrating disabled pupils at school. But it differs from the usual practice, which sees these pupils isolated and separated from the rest of the class, so as to allow “normal” learning to proceed without the “disturbance” of the pupil under the support teacher’s control. It is precisely this situation of separation that the mother wanted to avoid for her daughter. Top

4. The various forms of colour blindness are usually of genetic origin. Protanopìa is the condition where the blindness is more accentuated for the colour red; deuteranopìa where the blindness mainly concerns green; tritanopìa where blue and yellow are confused; achromatopsia when the colour blindness is almost complete. To rapidly check the form of colour blindness there are various tools available on the Internet. Top

5. The Author refers to a classical psychoeconomics experiment conducted by D. Kahneman, G. L. Knetsch and R. H. Thaler. The book fails to cite the  scientific work where the  experiment was presented by the Nobel prize winner for economics and his colleagues. Top

6. Classical economics theory hypothesizes that the propensity to pay to buy an object or a good must be equal to the propensity to be paid to deprive oneself of the same object or good. The theory talks about “willingness to pay (WTP)” and of “willingness to accept (WTA) compensation to be deprived of the good”. The endowment effect, on the other hand, says that people attribute a higher value to objects or goods that are in their possession, if compared with the value attributed to the same objects, if they are not owned and  have to be bought. Top

7. My italics. Top

8. My italics. Top