From a personal point of view it was a dive into my intimacy as I had never experienced before (although I'd already been in therapy for quite some time); from the professional point of view I was impressed by the direct and personal manner in which the therapist interacted with us. I began to study Gestalt therapy, ever more enthusiastic about its concepts and its existential and holistic view of Man. Parallel to my training in Gestalt therapy, I started working as a therapist. During my first years as a professional, I had some experiences that were very significant to the later development of my work. Some had to do with the consequences that might originate from uncarefully made diagnoses. One example occurred in na institution for the very severe mentally handicapped, with a child diagnosed by his very low I.Q. as "idiot". In fact, as I was able to verify, he happened to be a child with a very high degree of hearing deficiency.

Another significant experience happened during job training, still as an undergraduate, in an institution for the physically handicapped in the physiotherapy area. I worked with a boy who had progressive brain paralysis, although I had no knowledge of his diagnosis. Our relationship, which was very difficult at first, quickly changed into an affectionate one, due to the respect and consideration I had towards his difficulties. My surprise came at the end of the training period, when I decided to personally bid farewell to each and every child and mother. This boy's mother was shocked when I told her I would not work there any longer and expressed her worries concerning the worsening of his condition should our work be interrupted. At this point and for the first time, the diagnosis of progressive brain paralysis came to my knowledge when she told me that her son's doctor had been puzzled by the slow progression of the boy's disease from the time I had begun working with him. I was surprised for I thought my work with this child had been limited to exercises in the pool. That taught me one thing: respect and regard for the difficulties of the had a therapeutic effect and it took me many years to grasp all it's implications. A third type of experience that contributed to changing my professional life occurred with a patient who sought me for therapy and who, in our first session, said: "I am falling down a cliff and I'm holding on to the end of a rope. I need you to hold the other end". I knew something serious was going on, but due to my inexperience I was miles away from understanding the gravity of the situation. For a whole year that patient would systematically miss her sessions, arrive five or ten minutes before her time was up, or or two hours before the started, staying in the waiting room studying, eating or sleeping, or else she would do all this after the session. At times she would call me at home very late at night, telling me she was alone somewhere in the street, feeling she would faint, die, imagining she had a brain tumor, and things of that sort. At the time I did not understand what was going on and the only thing I did was to be there, patiently, week after week, month after month. In the second year of therapy, after telling me how much she had spied on my life and on my relationship with other patients she started to show up more punctually and more frequently at the sessions and, in a very slow pace, we continued our work.

After more than two years we reached a stage where I had the impression that the therapy was no longer effective. With grief and absolutely conscious of my professional limitations, I suggested that the patient should change therapist, and recommended a colleague. In our last session, that patient brought me a gift: a
children's play which she had written - the story of two children who fall inside a toy chest and end up on a desert island where there is nothing: neither people, nor food, nor even a way to go back home. One of the children then remembers that in her is a seed. She plants it; a tree bearing fruit is born; the children feed themselves on fresh fruit and then cut the tree down to construct the raft which would take them home. It was a moving story and I understood that I had actually held the other end of the rope so that she would not fall off the cliff. That was all I could do, thanks to the help of one of those guardian angels who protect inexperie nced therapists, guiding them along the roads of intuition. Intuition is an important instrument for psychotherapeutic work, though doubtlessly insufficient.

Those experiences led me to reflect deeply upon my practice as a Gestalt therapist. Many years went by before I was able to acknowledge to what extent they had determined the course of my study and reflection, resulting in a significant change in my work.

I want like to share some of the outcome of such change by talking about my comprehension of healthy and unhealthy functioning and diagnosis - which I conceive as process oriented diagnostic thinking.

HEALTHY FUNCTIONING AS AN INTERACTIONAL PHENOMENON

In Gestalt-therapy, we have a holistic conception of man, a bio-psycho-social being considering his multiple dimensions: physic, affective, intellectual social and spiritual. Experience is the result of the interactions of the individual with the environment. Contact and awareness enable the individual to experience interacting with the environment.

Awareness refers to the capacity one has to realize what is happening inside and outside oneself at the present moment physically, mentally, and emotionally. It is the possibility to perceive, at the same time, the inner and outer medium through perceptive and emotional skills, although in a given moment something may become more prominent. Awareness needs contact to take place, albeit there can be contact without awareness.

Contact takes place through contact functions: senses of seeing, hearing, smelling, sensing, language and movement. The contact functions organize our perceptions and give meaning to our feelings. Contact that occurs with poor awareness is a contact that does not have quality. Contact process that has quality allows a nourishing interaction between the individual and the environment so that changes may occur in the person-environment relational field, in other words, growth and development.

In our lives we have distinct and interrelated needs: physiological ones, like eating, drinking, sleeping and so on; and psychological ones, such as the need of relating to the other, of expressing our emotions and affections, of being loved and respected. Throughout development, these same needs become more complex and embrace different spheres of social and cultural insertion. Whatever the nature or the scope of the need it becomes manifest in the person/environment relational field.

From the beginning of life a person's experiences are relational. For newborns this field is greatly delimited to the mother-baby relation. The mother, through her awareness has the possibility to capture empathetically her baby, perceiving his/her needs. As she is the one who, at the same time, supplies the physiological and psychological needs of the child and is loving and respectfully there for him, the mother is the first significant other with whom the child has contact. She constitutes a first and important possibility for the establishment of relationship and in this relational field mother/newborn, the developing process will take place. As far as the newborn feels safe, he/she will develop his/her potential and amplify his/her contact with the world, widening increasingly the scope and complexity of his/her experiences.

However, although the baby is often thought of as being the "one who depends" there is also an interdependency, a mother-child reciprocal relation, an interplay of mutual satisfactions. At the same time as the mother satisfies her baby, she herself feels satisfied; as much as the baby needs to be nursed, the mother also needs to alleviate the pressure of her milk filled breast; physiological and psychological discomfort felt and manifested by the baby, correspond to discomforts of the mother herself. Her reactions towards satisfying her child also fulfill the mutual function of satisfying herself. Therefore the mother/baby relation comprises interdependency and a certain mutuality. Loving and respectfully being with her baby implies accepting him/her as he/she is and this will promote his/her differentiation processes and the development of his/her individuality. This process of becoming a unique individual derives from the relation with the other and, once the other is part of the environment, what enables healthy psychic development is the healthy person/environment interaction, I-non-I, through which the satisfaction of needs will occur - especially the one I consider fundamental: the establishment and maintenance of the relationship with the other.

The meeting of needs occurs through creative adjustment - the capacity of actively interacting with the environment at the contact boundary, adapting, when necessary the demand of our needs to the environment's possibilities of fulfillment.

Creative adjustment involves awareness of our needs, as well as the capacity of attributing priority to them, according to what Perls called hierarchy of values or dominances (1951, p. 277-278; 1973, p.7) referring to the fact that when several needs come into existence simultaneously the person attends to the dominant survival need first. As far as the person may experience during his/her development a respectful and loving relation, having the possibility to express his/her needs (of any nature) and exercise her potential, he/she has the possibility to develop as a unique and singular individual, interacting with the environment through creative adjustment, according to his/her hierarchy of values.

Albeit I am focusing the development process from the relationship mother/newborn, similar processes occur in other types of relationships throughout life, but there are two main differences: First: the degree of dependence between the individual and the other is not the same as between the mother and her newborn. According to the different stages of development the individual goes through, his/her independence and autonomy gradually increase. Although the need to relate with other remains, the nature of the relationship changes: while the degree of dependence decreases the degree of reciprocity and mutuality increases. Second: as development and maturity processes are amplified, wider is the scope and complexity of the experiences the individual deals with and greater are the possibilities to cope with them.

I consider healthy functioning an interactional phenomenon, that occurs at the contact boundary and which concerns the ability to relate to the environment, as unique persons, in a creative way in order to meet ones needs, maintaining, at the same time, a relationship with the other, respecting this other's uniqueness.

UNHEALTHY FUNCTIONING AS AN INTERACTIONAL PHENOMENON

Throughout development the satisfaction of certain needs may compete with the maintenance of the relationship with the other. When this happens the person, through creative adjustment, will seek different ways of expressing his/her needs, maintaining, at the same time, the relationship with the other. However, if this attempt also fails there will be conflict. As the mother is the one who is needed to attend our earliest needs, this conflict can become crucial when it emerges early in a person's life. In a less crucial, but still important manner, the same can apply to other significant relational experiences throughout. If the attempt of expressing needs in different ways repeatedly fails, in order to diminish the conflict and maintain the relationship, given the hierarchy of values, the expression of needs can become distorted or suppressed. The adjustment, instead of functional, will become dysfunctional; the functioning, instead of healthy, will become unhealthy. Once, as previously mentioned, our contact functions organize our perception and give meaning to our feelings, unhealthy functioning implies a certain degree of disorganization or distortion in one's universe of perceptions and feelings that may interfere in awareness processes. Under these conditions the relationship that the child establishes with his/her mother, instead of being secure, will favor the emergence of feelings of helplessness and insecurity that will interfere with the quality and possibility of development of the child's potential, as well as with the possibility of amplifying the scope and complexity of his/her experiences.

Tobin referes to this process as "adaptative survival-necessary responses to difficult childhood situations" and says that these responses are being maintained in present current situations because they seem to be similar or identical to past situations. In his opinion people did have other possible choices although they felt as if they didn't have them (1983, p.76). Considering Tobin's argument I want to discuss three questions: First: I find it interesting the way Tobin has named the result of this process, except for restricting it to difficult childhood situations. Although I agree they occur and are significant especially in difficult childhood situations, when the need of maintaining the relation with the is more important and the conflict more crucial, these adaptive survival-necessary responses do occur in response to other significant difficult situations throughout life.

Second question: my understanding of the fact that people did have other possible choices although they felt as if they didn't, is that they could not make them, and this should not be understood as a linear causality relation, that is, that the parents were so "bad" that the person didn't have any other alternative or as if the person didn't want to make another choice. What has to be taken into account is how the person perceived the event and how he/she reacted to it, that is, from what ground that figure emerged so as to acquire such meaning. The choice made by the person is always the choice that person, in that circumstance, with that experience, could do. The choice was founded in a need a consider legitimate: of psychically surviving and maintaining the relationship with the other. I believe this choice always presupposes the Gestalt principle of pregnanz according to which, psychological organization will always be as "good" as the current conditions allow them to be (Koffka, 1975, pg. 121). The principle of pregnanz is the presuposal of our concept of organismic self-regulation, according to which, as stated by Latner, the organism will do its best to regulate itself, given simultaneously its capabilities and the resources of the environment (1973, pg. 15). My understanding is that the adaptive survival-necessary responses we observe in unhealthy functioning result from organismic self-regulation processes, are (in it's origin) creative adjustments and constitute what is possible. Third question: as I mentioned before, unhealthy functioning implies in a certain disorganization or distortion of the universe of perceptions and feelings and this is the reason why, as Tobin says, the present situations seem identical to past situations

I consider unhealthy functioning an interactional phenomenon, occurring at the contact boundary and concerning the inability to relate creatively to the environment, relating instead by means of cristalized and repetitive patterns, thus distorting or supressing the expression of needs, in order to maintain the relationship with the other, however artificial or unauthentic this relation may be.

The more intense the need and the greater the difficulty of its expression and satisfaction, the greater the probability of more serious symptoms (physical or psychical).

PROCESS ORIENTED DIAGNOSTIC THINKING

Up until the seventies Gestalt therapists as well as the humanistic movement and anti-psychiatry opposed to the idea of using diagnosis. Diagnosing was said to be depersonalizing for reducing persons to concepts and categories that bring no contribution nor for understanding the patient nor for his growth.

I believe that they thought this way, maybe because they only considered the diagnostic criteria, which aims to verify the commons among individuals. Therefore they group, nominate and classify what refers to the loss of normal mechanisms of functioning (as DSM IV, CID 10, etc. Although this kind of classification can be useful, once it proportionates a shared language important to the inderdisciplinar work, it does not suffice our needs.

Diagnosis in the field of Psychology has to been thought from a different perspective than de medical model, because, according to Rogers (p.220-221), the medical model assumes that: An organic situation has a cause that proceed it; The control of this situation is more probable if the cause is known; The discovery and exact description of the cause is a problem that can be scientifically investigated.

The medical model, as described by Rogers, frequently leads to a linear and causation mode of thinking that is not sufficient for understanding the psychic complexity, dynamics and singularity of each human being. If the diagnostic criteria offer some commonality (that what is common to all human beings), they lack on singularity (that what is different, proper, and singular to each human being). Diagnosis in the field of Psychotherapy has to be understood as a description and comprehension of the person in his/her existential uniqueness.

Diagnosis cannot be linked to a disease or abnormality, but to someone's way of being.

In psychological literature, we frequently find a distinction between diagnosis and psychotherapy insomuch that the goal of diagnosis is to investigate, while the goal of psychotherapy is to treat. Before starting therapeutical work I find it necessary and helpful to investigate in order to have some initial understanding of the patient. Along the therapeutic process, however, investigation and treatment interweave. We are always asking ourselves what is going on and, in service of what. Diagnosis follows the psychotherapeutic process taking into consideration the patient's growth; changes that take place throughout time in his/her relation to himself/herself and to others; and within his/her inter and intrapersonal world. Diagnostic thinking continuously changes along the therapeutic process and in order to clarify this idea I have chosen to call it