Psychotherapy – an inseparable part of holistic approach in the treatment and dealing with endometriosis
Ireneusz Gawkowski
  1. What role does a psychotherapist play?

    Psychotherapy is a relatively new profession, although it requires many years of training in psychotherapy and supervision. It fits into healing and support activities, similar to psychiatry and psychology. In my personal professional experience, the role of a psychotherapist is to accompany a person who struggles with suffering by discovering its personal resources which may help to deal with the problem. It seems very obvious and simple. However, as it turns out in practice, it can be extremely difficult and sometimes even impossible. An important difference between the role of a therapist in the process and a friend or partner is the common background, which the therapist and the patient do not have. Partner, family or friendly relationships are difficult and full of wounds. It can be more colloquially said that the therapist is not “entangled” in the private life a patient and does not take any stand against his attitudes and decisions. The first session is really the beginning of creating a new relationship between a therapist and a patient. You can sometimes find the opinion that the patient comes to the psychotherapist “for a relationship”. That is, through honest openness and trust, giving yourself the chance to learn and co-create an interpersonal relationship. Psychotherapy focuses on the direct and sometimes deep encounter between man and man, with all his experience. In such a relationship there is no room for assessment or instruction. It is a common search for the deepest content of the patient’s existence and acceptance of it in its entirety. It sounds quite pathetic, as if the therapists were omniscient and had a monopoly on life. It is not. It should be remembered that a therapist, apart from his knowledge and professional experience, works himself. Rather, the picture of a silent analyst has passed away (I have a silent hope that psychoanalysts from the Freudian trend will not be offended). Today the psychotherapist should be authentic, that is, his way of life, what he says, his view of the world, should be consistent. This creates trust in contact. In today’s understanding, psychotherapy is the art of using psychological concepts in a way that most effectively helps the patient. The patient is the most important in psychotherapy. The therapy focused on the therapist, i.e. listening to and putting into practice his words, is not psychotherapy. There are many studies that confirm the thesis that from the whole cake: efectiveness in psychotherapy, the most important thing is the therapeutic relationship, or how others say the therapeutic covenant. It is only at a further point that there are elements such as therapeutic techniques and procedures, therapist’s knowledge and skills, patient’s readiness and others. It seems that integration psychotherapy is currently at the forefront, taking into account human understanding and its functioning in various aspects.

    2. For years we have been struggling with chronic disease, which is endometriosis. For many of us, this is a burden not only physical but also psychological, with which it is increasingly difficult for us to overcome. How to recognize the moment when we should ask for psychological help?


It is never too late and it is never too early. As a rule, people experiencing chronic suffering, for example related to chronic or incurable disease try to cope alone. Why? The answer is very simple: I can manage, I am not defective, I will not talk about somatic illness to someone who is not a doctor. These beliefs work on the unconscious level. Everyone would like to have a sense of agency in their lives. The incomprehensible myth is still lingering, when asking for help we agree to reveal our weakness. Fortunately, thinking about psychological or psychotherapeutic help as something shameful is decreasing. I think a good argument is the opinion of a gynecologist who redirects some of his, patients to me. One of them said: “Actually, I do not know why I came, my doctor said that he does not know my psyche and recommends a visit to a specialist. He gave me your telephone number. ” One session was enough for the patient (being in the second pregnancy, her husband walking with a pram with the first child under the study) to realize that she is living a good life, has a loving husband and is a strong woman. What was difficult for her, was the desire for total and immediate inexperience of fears related to the birth of a child. She recognized that fear, when we tamed it and understood that it is our helper and collaborator. It informs us about various threats and allows you to make safe decisions. Therefore, it seems to me that when personal attempts to remedy your suffering does not bring results, you should ask a specialist. I will venture to say that prevention is always easier and less painful than treatment. This means that maybe a few sessions at the beginning of unsuccessful attempts to cope, can bring relief and peace. I met with sick people who, still walking through different doctors, still did not know what was wrong with them. Doctors prescribed them various medications that did not help. Under such suffering lies old wounds, unresolved and often unconscious conflicts. Body, defending itself against confrontation with these difficult emotions, signals symptoms in the form of  somatic illness. At the basis of somatisation, there is always a psyche. It is impossible to discover it yourself and stop it. This vicious circle must be stopped by someone from the outside. Of course, someone who can notice, understand and properly intervene.

3. They are people who walk hard outside, inside they cry for help. Often these people do not want to admit it. How can a loved one, recognizing this hidden suffering, help and should he impose this help?


What constitutes us humans, is a relationship. I repeat it like a mantra: why live alone? In this question, however, I notice several areas. The first is the fact that someone seems to be hard outside. What does it mean? Does this mean that they have a lot of resistance to suffering and the ability to satisfy it in a satisfying way? Or maybe it means that such a person does not want to, for some reason, or is afraid to say that he needs help, crying out from within. If this is the case, then the question should be asked: why do they, if they suffer and what  such a hypocritical attitude gives. Perhaps the point is to show your independence in the relationship and feel a bit of satisfaction, or maybe the point is that the previous experiences show that someone close to you can not help, or even derives morbid satisfaction from suffering of others or addiction to a suffering person. Another level is the matter of helping others. Sometimes it is so that when we see a loved one in a great pain, we turn away from him because just looking at the pain causes suffering. Sometimes, after using the possible variants of help that did not bring the expected improvement, we are so tired that we somehow become emotionally immune. We become insensitive, frozen. There is also a situation that in a loving relationship, one of the parties will fall ill. So how can you help? Certainly not  hide what you see and hear. If we have known someone for many years, we have been  living under one roof and we have a model of trust developed, it is best to talk about our feelings. Sue Johnson in his book “Hug me” (I recommend to improve the quality of the relationship), gives some technique: DUZ. It means: Accessibility, Sensitization and Commitment. I am for You Also available in your illness, I am Sensitive to your pain, I  still want to be Involved in our relationship. Therefore, when I see you suffer, I am with you and I want to help you, but I do not know how. Please tell me what you need from me. If I could and could do it, I will do it. It’s very honest and maybe not very romantic. At these moments, we often struggle with a certain relational belief, which is completely untrue. He / she should know what I need. The real “two halves of an orange” know without words what the other person needs. Reality is less romantic, but more real. Personally, I am saying that such a question, “whether to impose itself on the help” could not be, if the love relationship is based on mutual trust and honesty. It means love through large M. When we know ourselves and the other’s  good and weaker sides, we are real and more grounded in ourselves. Speaking a little technical language, the more we tell each other, and we talk about ourselves (we inform), we have a greater range of needed solutions. Communication in a relationship is not a guesswork, but the  knowledge about the needs of the another person, experience in the relationship, constantly finding beauty in being together and sharing it.

4.We know that psychotherapy is an individual matter. But would you have such general advice for us as to approach this disease and how to find some positive sides in all this?

General advice? Hmmm, good advice allegedly paved the hell. But seriously; I have a few suggestions. Endometriosis should be approached as for any other chronic disease. Let’s look at alcoholism, it’s also a disease. The addicted  has to find some plus that he has been sick to stop drinking. I know it sounds unbelievable. But after deeper reflection, someone who retains abstinence enjoys a much better frame of mind and a lack of violent consequences of drinking such as family breakdown or loss of employment. It does not mean that he hates them . At least for today’s state of knowledge about alcoholism, they will be jeopardized by the psychological mechanisms of addiction, and please believe they are not pleasant. Personally, I’ve heard that such people are so happy about their alcoholism that they can live a real life and not wreak havoc around them with their drinking . They claim that thanks to illness, they have transformed their lives. Therapy and AA groups gave them support and help. If they did not experience this disease, they could still be bitter, selfish and self-centered. What good to find in endometriosis? It may be a chance for self-development, getting to know each other deeper and friendlier. It is the opportunity to experience new friendships  (of which you are a pioneer in the group you have set up) and to bring a specific mission to those who are still suffering. The sense of community in pain, including physical and mental, gives us the opportunity to accept what is happening to us. Nobody wants to be sick, but as argued in his beautiful book by Michael Haas, “The Expendables. Development after the trauma “, there is nothing more beautiful than the fact that we are not alone. The community gives strength and motivates to act. It is not about suffering, but about being able to cope with the suffering that happens to us. We have no influence on what will happen. But we have  influence on how we act. We always have a choice. A well-known psychologist, Albert Ellis, has developed a unique ABC model to describe the events we experience. By using it, you can capture your thoughts, feelings and behaviors. A -activating situation, the situation that activates your problem, eg information about the disease, we have no influence on it. B – beliefs, beliefs, or negative thoughts that contribute to the creation of negative imaginations and projections, eg this is the end, everyone will leave me, I will die, etc. This should be worked through in the psychotherapeutic process. And finally C – consequences, consequences of your imaginations, expressed in both emotions and behaviors. This can cause certain disorders such as depression and lack of self-confidence, but it can also manifest itself in the fact that we will not seek other help, eg in a support group or in psychotherapy. At the end, I would like to share a wonderful prayer: God, give me the spirit of my life, so that I can accept what I can not change. Take heart so that I can change what I can change. And wisdom, to distinguish one from the others