Clinical Phenomenology: A Method for Care?

I develop here one of the many topics raised by Sass, Parnas, and Zahavi, namely the role of phenomenology in clarifying issues not amenable to standard empirical methods. The authors of this scholarly paper mainly tackle this issue from the angle of psychopathological research in schizophrenia. I would like to build on their argument, having in mind one dimension of clinical phenomenology that has not been approached in their paper: the issue of care, that is the use of the method implemented by clinical phenomenology in the therapeutic setting.

Clinical Phenomenology in the Context of Research

I first briefly outline some methodological principles of clinical phenomenology in the context of psychopathological research that may be implemented in the context of care. Phenomenology provides a framework whose major aim is a wide-range understanding of the patient's morbid subjectivity, not constrained in a priori fixed schemata. By using standard empirical methods (e.g., rating scales and structured interviews) that inappropriately assume a priori systems of meanings that can overwrite personally structured meanings and narratives, interviewing may turn out into a tautological enterprise avoiding the assessment of those phenomena that are not included in predefined diagnostic schemas, impeding the evolution of psychopathological knowledge. Focusing only on a priori fixed variables and 'stretching' the patient's symptomatology to fit criteria entails the risk of the loss of relevant information. Phenomenology may be useful to integrate these shortcomings in the research setting, being effective in hypotheses formulation and exploratory studies. Clinical phenomenology in the context of research is concerned with bringing forth the typical feature(s) of personal experiences in a given individual moving from the assessment of subjective experiences, through personal narratives, to trans-personal constructs (Stanghellini and Ballerini 2008). Trans-personal constructs are based on a holistic approach, advocating the importance of the global grasping of a phenomenon as an organizing and meaningful structure over a particularistic focus of attention. They are central exemplars of a wide range of personal narratives. Also, they may be the starting point to elicit operational criteria to accurately describe a psychopathological phenomenon or to define single items to build up specific rating scales—an outstanding example of this being studies on self-disorders in schizophrenia (Sass et al. 2011).

Clinical Phenomenology in the Context of Care

In the context of care, we are essentially concerned with the level of personal narratives. Patients are encouraged to report their experiences and posit them in a meaningful context, that is, a narrative format. Narratives are the ordinary forms through which we attempt to order the sense and meaning of our actions, experiences, and beliefs. Narrative reasoning is the ability to use structure above the level of the sentence, hence above the level of single experiences; narratives establish a form of organization in autobiographical memory providing temporal and goal structure, combining personal experiences into a coherent story related to the self.

Narratives are personal, meaningful reconstructions of one's actions, experiences, and beliefs. These are not immediately given as a narrative. Before that, they are given as a text, that is a discourse that contains a structure—but this is prima facie an invisible as well as unintended structure (Stanghellini 2010). The point, then, is how to rescue this invisible and unintended structure.¹ All human deeds can be produced or reproduced as a text. The text—be it oral or written—is a work of discourse that is produced by an act of intentional exteriorization. One of the main characteristics of a text is that once it is produced, it is no more a private affaire, but is of public domain. It still belongs to the author, but it also stays there "independent with respect to the intention of the author" (Ricoeur 1981, 165). The externalization of one's actions, experiences, and beliefs via the production of a text implies their objectification; this objectification entails a distantiation from the person herself and an autonatization of the significance of the text from the intentions of the author. Once produced, the text becomes a matter for...