Introduction

When the patient exposes his manifest motive in a psychological consultation, it is common for the interviewer to understand the concepts that the patient describes, without clarifying their meaning, leaving the interviewer confused throughout the interview, without having any guidance on how to help or provide a psychological service.

It is common for patients to be referred by relatives or an institution; establishing the same referral as a reason for consultation; again, the interviewer may take it for granted that this is an overt motive, when in fact it is not. This situation leaves the therapeutic process vulnerable, initiating a treatment or pseudo-process, making the patient see "as if" he would glimpse what he is going to, why he is going, what he expects and how he can be helped, without paying attention to the patient's fantasy about his symptom. Or about the representation it has about its external world. By continuing with the sessions the patient will sooner or later abandon the treatment by conceiving that he is not being understood.

Therefore, it is necessary that both the manifest reason for consultation, as well as the real demand, that is, the latent reasons, are understood and clear by the therapist in order for the patient to know that he is being listened to and in this way leave forging a working alliance with solid foundations, diluting false expectations about therapeutic treatment.

For ^{Martínez (2006)}, the reason for consultation refers to the explanation given by the patient at the beginning of a psychological consultation about their symptoms; the frequency, the beginning, the severity, trying to describe the signs of her condition. However, the concept of the real demand or latent motive, implies not only the description of the symptoms, but also that the patient shows his need and desire for help.

At the beginning of the interviews, the therapist tries to investigate everything related to the reason for the consultation, he inquires about the symptom and the signs, leaving aside what is implicit in the patient's speech, that is, that sometimes the interviewer only focuses on discovering the signs of the symptom without taking into account whether in his story there are signs of awareness of the disease or if the reason is related to his speech, his behavior and his history.

This research is qualitative, descriptive-explanatory design; 20 medical records were made of patients who have attended the Centers for Intervention and Psychological Services (CISP) in the state of Zacatecas, as part of the social work implemented by the Autonomous University of Zacatecas (UAZ), currently there are more than 14 centers distributed throughout the state. These centers provide psychological care to the university population and people with low economic resources. These are attended by teachers of the Psychology Unit and by students who carry out practices and are complying with their social service for their professional performance. The teachers who work in the CISPs have the obligation to provide advice and supervision to students who are exercising therapeutic activity. The authors of this research were supervising the students who provided psychological support in the CISP while they performed their social service. For almost 3 years, clinical cases attended in the CISP were collected in order to determine the various motives of the people seeking psychological help, as well as to identify if the manifest reasons are clear, if there are expectations of treatment, awareness of the disease and if there is any relationship between latent motives. It was detected that the people who requested psychological help did not last long enough in a therapeutic treatment, they abandoned the treatment in the first sessions. It was discovered that the interviewers may not obtain enough information to be able to understand part of the subjectivity of the patients and to establish how a better therapeutic service could be provided to the CISP applicants.

Método

It is a qualitative study, with a descriptive-explanatory design, which includes the analysis of semi-structured interviews (history cases), ^{Díaz (2002)} considers that the interview is an interpersonal link between the interviewee and the interviewer, through which it can yield valuable information. Clinical histories have the purpose of understanding the constitution of the information and knowing the causes from its history (^{Cadena et al., 2017}). ^{Fernández (2017)} maintains that qualitative research allows understanding, register and knowing expressions and behaviors in relation to the object of study. The interviews conducted were supervised by the authors of this research over a period of 3 years. As ^{Taylor and Bogdad (2000)} point out, it was ensured that no directive questions were asked or value judgments were made, the themes that emerged in the interviews emerged from the interviewees themselves.

Results

Discussion

The subject seeking help is because something afflicts him, there is some kind of suffering, something that may be confusing to him, perhaps it is anguish, fear, sadness or some other condition, and what is sought in a first interview and throughout the treatment, is that the subject finds and realizes how and in what way he is expressing his suffering, although at first it seems that there are disconnections between the patient's speech, each element belongs to a set of systems which are related to each other (^{Coderch 2015}). Therefore, the interviewer must try to be attentive and look for a thread throughout the interview speech.

It is important to know what and how to ask, ^{Morrison (2017)} suggests that the purpose of the first interviews is to obtain enough information for the interviewer to glimpse and be clear about why a psychological interview is being requested. It is necessary for the interviewer to develop technical and theoretical skills to conduct himself within the framework of the interview and in this way establish a therapeutic alliance.

^{Beichmar (2011)} considers that within the unconscious there are mobilizations where fantasy and other elements determine the level of anguish, the type of defenses that operate in the ego and the symptoms manifested by the subject are manifested as resistance in the psychological interview. As ^{Aramburo (2016)} points out, the fantasies come from the unconscious and the symptoms that occur in the cases are covered with various fantasies that come from evocations of memories and desires.

Although the symptoms seem align with the subject for ^{Shedler (2010)}, the purpose of the interviewer is to find the meaning of such symptoms, they belong to their psychic context, and it is part of the therapist's job to facilitate the connection of the symptom with the patient's experiences. It is necessary to connect events, feelings and desires; All these aspects give meaning to the manifest motives, their symptoms and their history. ^{Bahamondes and Moderel (2020)} reflect on the symptom as something that is perceived by the patient himself, experiences it as a foreign entity that gives it a meaning from self-observation, situations and experiences which in the clinic the subject will have to go integrating. The therapist will have to help, be flexible and with the capacity for abstraction to lead the patient to be able to manage, organize and discover the meanings about her own symptom in such a way that the subject is perceived as an integrated being. Returning to ^{Bornstein (2018)}, the evaluation of symptoms is not enough for the subjective understanding of the patient; it requires a wide range of conceptual and technical domains in psychotherapy.

According to ^{Liegner (1977)}, it is essential that in the first interviews the therapist will have to diminish the obstacles that are being presented in the communication of the session. An obstacle could be the fantasies and expectations that are had about the treatment and one of the ways is to reach a verbal agreement, in which the conditions of the setting are established, the way of working, what is possible to attend and what it is out of the reach of the therapist. In most cases, expectations are confusing, and only a few clearly state what is expected of treatment.

As ^{Bleger (1995)} points out, if a person goes to a psychological consultation it is because they have a vague idea that something is disturbing them and that they cannot fix their situation by themselves, depending on their pathological condition, anguish emerges which is intolerable and defensive mechanisms are activated such as denial, which the subject apparently is not aware of what is happening, goes to consultation, but does not clarify his reason, the subject has a certain diffuse notion about his problem but it is not clear why he is going to treatment.

Regarding the analysis of the correlation and homologation of keywords of the manifest and latent motives, following ^{Corral (2001)}, the latent indicators are related to constructs that cannot be observable, unlike the manifest ones that can be recorded through observation during the interview. However, the latent content is inferred theoretically on the basis of overt indicators. Observation within a therapeutic context requires analytical listening and investigative clinical observation; these two allow perceiving the internal conflicts of the patient; they give a guideline to find meanings in the patient's speech, addressing unconscious and conscious instances. Analytical observation is not only about being aware of everything that is presented as manifest, it is about seeing the background and being attentive to the patient's fantasies and the fantasies that are built within the therapeutic relationship (^{Bernardi 2018}).

Unlike the research by ^{Muñoz and Novoa (2012)}, which refers to the fact that aggressive behaviors are seen more frequently, it was observed that in this research the majority go to the consultation as a result of concern about their moods and emotions such as sadness, despair, insecurity, devaluation mostly related to problems with romantic partners and family relationships. ^{Janin (2018)} runs that at present diagnoses incriminate subjects before a society that demands certain types of relationship, stereotypes, fashions and forms of expression; not adjusting to these normalities, they will be condemned to diagnoses imposed by others or by themselves; leaving aside much of the subjectivity and historicity of the subject.

^{Untoiglich (2015)} reflects on this, considering that the mental states and scenarios in which sadness, despair, anger or others are experienced are conditions that fluctuate in any human being throughout his life, however today, at present, these conditions are seen as mental disorders, society pretends to demand to be permanently happy, it is not allowed to feel, elaborate or experiment. The differences of each person can become a pathology that must be treated.

Developing listening skills accesses a broader understanding of the situation manifested by the patient. The relationship that is germinated between the patient and the therapist, in the first interviews, will determine the effectiveness of a treatment. ^{Jung et al. (2013)} considers that the initial interviews are fundamental to predict the relationship that will be established in the long term between the patient and the therapist. If the purpose of a psychological treatment is not clear to the therapist, it is very likely that the patient will drop out of treatment because the patient's fantasies cannot be sustained by the therapist. ^{Kleinbub et al. (2020)} recognizes that the link established between the patient and the therapist allows us to elucidate through bodily manifestations, affective and verbal contents the times in which the patient accepts and elaborates the indications and interpretations within the therapeutic process.

The pathological condition is subject to the fantasies that are generated about the expectations of the treatment. As stated by ^{Alexander (1944)}, the interview should be based on the understanding and structure of each patient, especially paying attention to the degree of ego functioning; if there is coherence in his speech, continuity of his story, observe bodily reactions, the way of facing situations in his life, observe how he is perceiving the psychological treatment, if it is accessible or not to the contents of his speech.

The understanding of the phenomenon for ^{Kvale (2003)} allows to elucidate the way in which the patient will work. If a high level of understanding and trust is established, a more efficient therapeutic treatment will be established. ^{Georgievska (2019)} agrees that the therapist will have to provide the patient with the tools based on the exploration of fantasies and recurring themes so that they can verbalize what they cannot recognize at the beginning of the treatment. On the other hand, ^{Mahon (2017)} states that inquiring about the symptom linked to the fantasy allows us to know and understand how said symptom arose and developed, that is; Not only will you have to be aware of the signs of the symptom, but also what surrounds it and the representations that the patient has about it, in this way, progress will be made to discover the origin of the symptom and the conflict.

For ^{De Celis and Méndez (2019)}, the psychoanalytic clinic would be more at the service of what happens to patients; In the discomfort of the present it is not about following a position to the core, it would be inoperative in the face of new situations that arise in the current context, now it is about being creative and having elements that enrich the therapeutic work, in the Today's clinic, theoretical positions must be adapted to be effective in what is happening today. ^{Diaz (2018)} recognizes the contributions of various contemporary psychoanalysts who have contributed to various theoretical and technical scenarios giving a controversial but necessary turn for the understanding of mental life.

Conclusions

It is essential that the manifest motives are clear to the therapist, inquiring about the symptoms and signs are essential to understand the real problem or the latent motives of the patient. Although at first it seems that they have no connection, they are articulated, they lead towards each other, allowing them to be linked with the speech, their problems, their desires and their history.

Other elements that must be taken into account when conducting the psychological interview are the expectations of the treatment and the awareness of the disease, these are linked to the fantasies that the patient has about the treatment and their desire for help, since that sometimes expectations cannot be identified, are unrealistic or unattainable, hampering a therapeutic process. It is important to verbalize and inquire with the patient what she is looking for in a treatment. By detecting the level of awareness of the disease, the therapist gradually recognizes the level of conflict that the patient has to realize their own problem; if the level is null or vague, the therapist is left at the mercy of being responsible for resolving their conflicts. The expectations and the level of consciousness of the disease also denote some pathological components of the subject such as mechanisms of denial, excision, projection, and others; the more unrealistic the expectations, the greater the pathological degree of the subject. If the expectations are real and there is a higher level of awareness of the disease, it is an indicator of the mental health of the person who consults.

Establishing with the patient what was understood from the first interview, allows the possibility of a greater commitment between the interviewee and the interviewer, the therapeutic alliance is fostered and real links are established allowing the advancement of the therapeutic process. It is essential that in the first sessions the therapist returns to the patient what he has understood about the reason and his expectations, as well as what can or cannot be achieved within the therapeutic work. The new forms of therapeutic approach due to the contingencies that have been established by the SARS-CoV-2 pandemic, have modified the situations to carry out psychological interviews, in these times it has been adapting to the use of virtuosity to carry out interviews and therapeutic treatments; However, the way of understanding the other, the intention to understand part of the subjectivity is the same, it requires theoretical and technical tools, as well as the establishment of the therapeutic alliance, essential elements to understand and help within the possibilities to who requests it. The limitations of this research lie in the fact that only medical records were highlighted in the state of Zacatecas. It is expected to be of interest for further research.