Theoretical grounds of workshop on patient communication using Gestalt psychotherapy approach

Introduction

The basic theoretical aspects of Gestalt therapy provide a solid foundation for developing a training workshop program for communication with patients. Building rapport in Gestalt psychotherapy is undoubtedly holistic in nature, and refers to emphasizing the awareness of the person’s current experience in the “here and now” as well as restores emotional and bodily sensation, allowing for the expression of emotions, such as anger, rage, sadness, anxiety, but also love, joy, and tenderness. This rapport is highly specific, involving the body’s creative adaptation to the environment, awareness of internal mechanisms, and repetitive ways of reacting, which prevent the fulfilment of needs and interrupt normal cycle, escalating fears, inhibitions, delusions, etc. [1].
Rapport in Gestalt therapy is distinguished by a specific type of relationship and creation of conditions for teaching an individual to recognize perceptions, feelings, and current emotions caused by experiencing a previous situation that was unfavorably resolved or left unfinished. Therefore, in a new and difficult situation, rapport can make it possible to see automatic reactions and behaviors, which are reflected in the present but have their roots in the past. Expanding the field of consciousness, freedom of choice, and moving beyond past conditioning, promotes taking responsibility for one’s choices and enables self-knowledge and self-acceptance [2].
It is assumed that people seeking therapy are the greatest authorities to their own perceptions, and have enough strength and skills to cope. Hence, they should be provided with the conditions to learn about themselves and their behavioral mechanisms, and experience contact with own emotions and bodies. Therapy and building rapport are therefore based on a partnership, and this rapport should foster strengthening of human awareness, pursuit of autonomy through a learning process, search for subjective truth related to the context and emphasis on self-responsibility [3].
In Gestalt therapy, a healing relationship is considered to be one filled with emotions and based on trust, where there is room for disclosure of emotional and sensory responses, emerging ideas and suggestions, which determine the quality of a relationship. In this type of dialogue, an individual has the opportunity to participate in restorative emotional experiences; it may also be the first time in their life that they feel heard, appreciated, and noticed [3]. The principles of Gestalt therapy aim to strengthen the client, awaken them, or mobilize to a degree that allows better coping with life, discover the proper relationship with their environment, increase their potential and self-sufficiency, and that they are not treated as ideology but rather are manifested in experience. Expanding consciousness is intended to lead to a person’s awareness of what they are doing and experiencing, to their identity, responsibility, and being in the present.

Building a relationship based on experiencing transference/countertransference

In Gestalt therapy, there are certain phenomena that underlie building rapport. It is of great importance what the client experiences “here and now”; this is why the client’s current and conscious experience in a therapeutic relationship is so important. Transference (although this term is taken from another approach) manifests itself as the way in which the client projects old relational patterns to the therapist, but instead of interpreting them as a reflection of unconscious conflicts, the therapist encourages the client to explore what is emerging at a particular moment. The client, who realizes that they are transferring old patterns into a new relationship, can experiment with other ways of being and recounting their feelings. Experiential techniques invite a shift in these patterns, of which the most well-known are “dialogue” and the “empty chair” technique or “two chairs” method, which help the client experience and understand these encounters [4].
The process of work in Gestalt with the use of this phenomenon is possible, because the therapist is encouraged to be authentic and present in the relationship. Therefore, the therapist’s emotional reaction to the client’s behavior, known as countertransference, becomes a valuable source of information about dynamics of the relationship. Working with the process of countertransference in mind becomes safe when the therapist can observe their own feelings to recognize which are the reactions to the client’s current experience, and which may stem from their own, unprocessed patterns. This reflection, in turn, makes it possible to better understand what is happening in the relationship, and to use this information in the therapeutic process. Both transference and countertransference are explored in the context of current experiences. Instead of classic interpretation, Gestalt encourages direct exploration of feelings and behaviors, which enables the client to understand how past relationships influence their current functioning. By openly sharing their feelings (in a way that is appropriate and tailored to the client’s needs), authentic contact where the therapist can help the client see how their behaviors evoke specific reactions, becomes a starting point for deeper reflection and change. In Gestalt work, it is crucial that both transference and countertransference are not treated as problems to be solved, but as opportunities to deepen the client’s relational awareness [5].
Minimizing the risk of transference and countertransference in therapy is a process, in which the therapist carefully observes and manages emotional reactions, both their own and the client’s, so that they will not interfere with the therapeutic process. The phenomena of transference and countertransference existing outside the therapist’s awareness can disrupt the therapeutic process, therefore care should be taken to prevent it. In order to do so, supportive measures for the therapist are as follows:
1. Recognition and self-awareness
– Awareness of one’s own emotions: The key element is the therapist’s constant monitoring of their own feelings and bodily reactions. Thanks to self-awareness, the therapist is able to distinguish between the reactions connected with the current therapeutic process and these stemming from their own, unprocessed experiences.
– Identifying personal emotional patterns, which can affect the way of interpreting the client’s behavior, enables the therapist to respond consciously, rather than automatically transferring unconscious content.
2. Maintaining the “here and now” in the therapeutic relationship
– Focusing on the current experience: The therapist concentrates on what is happening at a given moment during the session. As a result, transference and countertransference can be analyzed as elements of the current interaction, rather than as reflection of past patterns unrelated to the current process.
– Context control: Staying in the “here and now” helps maintain the situational context that reduces the risk of past emotions dominating the relationship.
3. Reflection
– Reflective practice: Systematic reflecting on the course of session and one’s own reactions facilitates early identification of the phenomena that may disrupt the therapeutic process; it is also important to document the therapeutic process.
4. Maintaining professional boundaries
– Clear relational boundaries: Establishing and maintaining clear boundaries between the therapist and the client help reduce the possibility of excessive transference and countertransference.
– Attitude modelling: By maintaining an authentic but controlled presence, the therapist provides an example for the client on how to cope with intense emotions without falling into unhealthy patterns.
5. Mindfulness techniques and emotional regulation
– Attentiveness practices: Using mindfulness techniques allows to maintain the therapist’s emotional balance and distance, which is crucial for observing one’s own reactions without responding automatically.
– Breath and body regulation: Breathing regulation techniques and attention to body signals help the therapist to maintain control over their own emotions, which is essential to minimize the risk of transference and countertransference [6].
To sum up, reducing the risk of transference and countertransference is a complex process that requires the therapist to be deeply self-aware, maintain presence in the “here and now”, regular supervision, and using mindfulness techniques. These activities enable the therapist to consciously manage their emotions and reactions, permitting transference to be used as valuable diagnostic information, rather than as a disruptive factor in the process. As a result, this support provides a safe space for transformation, minimizing the risk of re-traumatization, and maintaining healthy dynamics in the therapeutic relationship [7].

The phenomenon of resonance in Gestalt therapeutic relationship

Focusing on the current therapeutic experience allows the client to become aware of recurring relational patterns; the therapist’s own reactions become a mirror, in which the client can see part of their own process. An equally important aspect of this process is supporting authenticity and encouraging experimentation in the relationship, contributing to a better understanding of oneself and creating healthier inter-personal patterns. This type of approach not only strengthens the therapeutic process, but also helps build a relationship based on mutual trust and authenticity, which is the foundation of Gestalt psychotherapy. Work in the Gestalt approach in the context of the phenomenon of resonance refers to the mutual emotional attunement occurring between the therapist and the client. This is a process where both parties, thanks to authenticity and full presence in the “here and now”, start to experience similar emotions and sensations also at the body level, and respond to each other in a way that may reflect the client’s unprocessed relational patterns. Key aspects of resonance are mutual empathy, authentic reflection of emotions, and common attunement. Resonance can manifest itself both verbally and non-verbally through tone of voice, facial expressions, body posture, and somatic sensations. By being aware of their own reactions, the therapist can use this phenomenon to help the client better understand and integrate their emotions [8].
Mutual empathy in this case means that the therapist, thanks to their authenticity, reflects the client’s emotions, enabling a deeper understanding of their inner world. Authentic reflection of emotions is not only about listening but also feeling the client’s emotions, allowing for conscious notice of these feelings in the relationship; this permits the client to feel understood on a deeper level. The phenomenon of mutual attunement does not result from the therapist’s empathy, but is a process where both parties, i.e., the therapist and the client, share their emotional experiences. This mutual attunement creates a space where the client can safely explore their feelings and relational patterns. Seeing their emotions accepted and reflected by the therapist, the client is more motivated to open up and work on their difficulties. Mindfulness and empathy enable the therapist to notice which old patterns or transferences are activated in the relationship. This can be a starting point for experimenting with new ways of responding as well as exploring and integrating experiences within the relationship. Therefore, resonance in Gestalt psychotherapy can be considered not only a reflection of transference, but also a dynamic process of mutual attunement that enables the therapist and the client to work on an emotional level, leading to deeper awareness and integration of experiences [9].

Therapist’s role in experiencing resonance

The therapist’s tasks are to:
– Maintain presence: The therapist remains fully present and attentive, observing both their own reactions and what emerges from the relationship with the client. This allows them to perceive subtle changes and dynamics of the process without unnecessary interpretation at an early stage.
– Minimize interference: By refraining from immediate interventions, the therapist gives the client space to independently experience and process difficult emotions. This approach minimizes the risk of triggering unwanted reactions, such as re-traumatization, enabling natural flow of changes.
– Support transformation: Openness of the space facilitates a more profound deepening of an experience, which in turn lays the foundation for transformation. By being aware and accepting, the therapist enables the client to discover new ways of being, integrate difficult experiences, and work on personal growth [9].

Building therapeutic relationship in the context of field theory

Implications of field theory are reflected in the therapeutic process and relate to three key concepts: the phenomenal field, phenomenological field, and psychopathological field. The phenomenal field describes the atmosphere of a given situation and the conditions in which various forms of experience emerge, while the phenomenological field refers to the ability to reflect, enabling the therapist to distance themselves from immediate experiences and assign meaning to them. The psychopathological field, in turn, demonstrates how a lack of presence in the phenomenal field translates into the experience of suffering as an emergent relational effect [10].
From the perspective of Gestalt therapy, the classic concepts of transference and countertransference should be understood as the dynamics of constantly emerging relational processes, in which the self is not a fixed structure, but rather constantly evolving experiences. Modulating the therapist’s presence, i.e., the way the therapist can consciously adjust to forces of the field to support the client’s transformation, allows safe experience of difficult emotions and opens the way for therapeutic change, supporting the process of transformation and integration of clinical experiences.
The implications of remaining in the field of experience are conscious and reflect staying in touch with one’s own feelings, without reacting immediately. Referring to this in more detail, it is worth emphasizing that the therapist’s tasks in this process include:
1. Conscious staying in the field
“Doing nothing” does not mean passivity, but conscious remaining in the client’s presence, enabling the emotional movement that has already begun to unfold naturally. The therapist enters a state of the so-called “epoché”, a suspension of judgment, where they do not introduce their own interpretations or patterns, allowing the change process to unfold on its own. In this way, instead of intervening, the therapist focuses on observing what is emerging and presenting an open, non-judgmental attitude.
2. Trust in the transformation process
The key element of this intervention is a profound belief that the change process is inherently capable of self-regulation and development. As being aware of bodily and emotional resources, the therapist trusts in the emerging feelings, movements, and tensions’ potential to transform into something constructive. Such trust is not passive waiting, but actively holding space for transformation, which fosters building a safe environment, where the client can explore their inner experiences.
3. Non-intervention as a protection from re-traumatization
The “doing nothing” intervention is particularly important in situations, in which therapeutic intervention could disrupt the delicate process of change or even trigger re-traumatization. By consciously remaining present and not intervening, the therapist allows field forces, such as emotions or proto-feelings, to emerge freely, yet not codified by interpretive patterns. This gives the client the opportunity to independently experience and integrate difficult feelings, which is the foundation of authentic change.
4. Active “doing nothing” as a form of support
Although at the behavioral level the therapist does not take any specific action, their attitude is active and committed, involving:
– Conscious recognition and acceptance of movement: The therapist observes, identifies, and accepts the emerging sensations without immediately attempting to modify them.
– Maintaining an open space: By not interfering with the natural flow of emotional processes, a “space” is created, a metaphorical clearing (lichtung), where new possibilities and meanings can emerge.
– Trusting that the process is good in itself: This attitude allows the client to experience that their process is valuable enough, and the therapist does not need to “fix” them, but providing support through their presence.
In this model, the therapist does not impose their own interpretations or try to direct the change process. Their primary tasks are:
– Remaining present: Maintaining a full, authentic presence in the “here and now”, allowing the client to feel accepted and understood.
– Emotional distance: The ability to maintain inner balance and be indifferent to initial impulses, enables the therapist to observe what is truly happening in the field, rather than react impulsively.
– Supporting natural flow: The therapist actively chooses not to interfere, which is a form of intervention itself, based on trusting the forces of change and allowing the client to discover new ways of being [7].
The “doing nothing” intervention in Gestalt therapy is an advanced technique that requires the therapist to deeply understand the dynamics of the field and trust the natural process of transformation. By consciously staying in touch with one’s own feelings, maintaining an open space, and trusting in the process, the therapist supports the client in integrating difficult emotions, allowing authentic change without the risk of excessive interference. This approach is the foundation for a radically relational epistemology in Gestalt therapy, where the therapist’s presence provides active, yet non-intrusive support for the natural flow of change.
“Conscious remaining in the field” in the context of psychotherapy means active, full engagement in the ongoing therapeutic relationship, while maintaining a distance that enables observation and acceptance of what is emerging. For a Gestalt psychotherapist, it is not only being present but also consciously “entering” the dynamics of the field, i.e., the entire set of interactions, feelings, intentionalities, and experiences, which shape the therapeutic session.

Self-disclosure in Gestalt therapy

Gestalt therapy, as an approach focused on the “here and now” and relational authenticity, emphasizes the therapist’s presence in the process of treatment. Unlike more traditional methods, where the therapist remains a detached observer, Gestalt method encourages conscious and deliberate self-disclosure. Self-disclosure is a process in which the therapist consciously shares their experiences, emotions, or reactions in contact with the client. However, this is a tool that requires consideration; its purpose is not to satisfy the therapist’s need for expression, but to support the client in their process of self-discovery and change [11].
A fundamental question in the context of self-disclosure is where the line is drawn between the therapist’s authentic participation in the relationship and the risk of blurring professional boundaries. Gestalt underlines that the therapist is part of the relational field, with their presence and responses influencing the client. If the therapist experiences strong emotions in the relationship, e.g., they are sad, irritated, or moved, they can provide valuable information for both the therapist and the client. However, the decision to disclose the feelings requires reflection: Will this disclosure be supportive for the client at a given moment? Will it allow them to better understand their own process? Self-disclosure can take many forms. In Gestalt therapy, there are several types of self-disclosure, which can be used depending on the situation:
1. Revealing reactions “here and now”. The therapist can share how they are reacting to the client at a given moment, for example, “When you talk about this, I notice a tension in my body. I wonder if this is something you notice too?”. Such an intervention helps the client become aware of how their way of being affects those around them.
2. Revealing one’s own life experiences. In some cases, the therapist can share their own personal experience if they believe it will be helpful to the client. For example, the client may feel alone in their experience, and the awareness that the therapist has once gone through something similar can provide a sense of not being alone.
3. Revealing mechanisms of therapeutic work. Occasionally, the therapist can talk openly about their approach and process, for example, “I’ve noticed that when you start talking about your family, you often change the subject. I wonder what might be behind this pattern?”. This type of self-disclosure helps the client see how their narrative works and what mechanisms might be blocking it [6].
Thoughtful self-disclosure can bring many benefits to the client. Firstly, it can build authenticity in the therapeutic relationship; the client feels that the therapist is a living, real person, not a distant, analytical observer. Secondly, it can help normalize the client’s experiences; knowing that the therapist also experiences difficult emotions or has had similar experiences can reduce the feelings of isolation. Thirdly, self-disclosure can be an opportunity for the client to express emotions openly, yet with attentiveness and respect for other people’s boundaries.
Self-disclosure in the therapeutic relationship can be connected with some dangers, while unconsidered self-disclosure can become a trap in the therapeutic process. There is a risk that the therapist will start talking too much about themselves, shifting the focus from the client to their own experiences. This can lead to a situation where the client begins to care for the therapist instead of focusing on themselves. Moreover, self-disclosure may be perceived as an attempt to impose one’s own way of thinking or values on the client, which is contrary to the idea of Gestalt therapy that seeks to support the client’s autonomy.
For self-disclosure to be effective, several requirements must be met:
1. Self-disclosure should be the therapist’s conscious choice; not driven by an emotional need, but by deep consideration of whether it will be valuable to the client.
2. It should be consistent with the relational context: If the client tends to focus on others, excessive self-disclosure by the therapist can deepen this pattern.
3. It should leave space for the client: Self-disclosure should not become dominant in the relationship, but serve as an impetus to intensify the client’s process.
4. It should be tailored to the stage of therapy: At the beginning of the therapeutic process, it is better to focus on building a safe space and only later, if appropriate, use this tool.
Self-disclosure in Gestalt therapy is a tool requiring considerable attentiveness and self-awareness of the therapist. It can strengthen the therapeutic relationship, help the client integrate experiences, and build an atmosphere of authenticity. However, its use requires reflection; the therapist should always consider whether their disclosure serves the client’s process, or perhaps stems from their own emotional needs. Properly used, self-disclosure can become a valuable element of the therapeutic process, which strengthens the client’s transformation and deepens their self-awareness [8].
Lack of self-disclosure is also the therapist’s conscious choice. In some situations, a deliberate decision not to disclose oneself and remain open to one’s own resonances, can have a greater impact on the therapeutic process than active sharing one’s feelings. This approach requires a high level of the therapist’s self-awareness, ability to regulate their own reactions, and willingness to explore what arises in the relational field without immediate intervention.
Lack of self-disclosure does not mean distancing oneself or lack of involvement in the therapeutic process. On the contrary, it is a conscious choice to remain fully present with the client, observing both their experiences and one’s own reactions, without the need to immediately share them. This is a form of deep empathy, in which the therapist allows their inner experiences to provide them with information about the relational field, but does not interfere with the natural unfolding of the process. This approach enables the client to remain the primary narrator of their experience, without burdening them with additional content from the therapist [12].
Resonance in Gestalt therapy refers to the therapist’s internal reactions to what is happening in the relationship with the client. These can include subtle bodily sensations, emerging emotions, associations, or thoughts emerging in response to the client’s behavior and statements. By remaining curious about these sensations, the therapist can gain valuable information about the relational dynamics and what is happening in the therapeutic field. By not revealing these sensations immediately, they allow them to develop and display a fuller meaning.
For example, if the therapist feels a sudden bodily tension during a session, it may signal that fear, anger, or an emotional block is emerging in the relational field. Instead of immediately interpreting this feeling and sharing it with the client, the therapist can allow themselves to observe and reflect: “Is this my personal reaction? Or does it reflect something happening within the client?”. This approach enables a deeper understanding of the session’s dynamics and conscious and more precise interventions at an appropriate moment.
One of the main reasons why the therapist may choose not to disclose themselves is to leave the client some space for independent exploration. When the therapist reveals their reactions, they can unconsciously direct the therapeutic process towards their own perceptions, rather than allow the client to discover their unique experience. Not disclosing oneself enables the client to connect more deeply with their emotions, supporting their autonomy.
For example, when the client begins to talk about a difficult family relationship, but their statements are halting and tense, the therapist may feel a strong agitation or impulse to share their emotions. However, remaining open and observant allows them to recognize that the client is just beginning to explore their feelings, and does not need additional external stimulation at this point. Crucial is not what the therapist feels, but what the client is ready to notice and experience at their own pace [7].
Too much self-disclosure by the therapist may lead to several risks in the therapeutic process:
1. Change in dynamics of the relationship: The client may unconsciously begin to care for the therapist or adapt their behavior to what the therapist reveals.
2. Limitations to the client’s independent process: If the therapist reveals own reactions too quickly, the client may begin to follow the therapist’s interpretation, rather than explore their own emotions independently.
3. Countertransference threats: In some cases, self-disclosure may stem from the therapist’s personal, unprocessed emotions, which can introduce unconscious patterns into the therapeutic relationship.
By being aware of these risks, the therapist can adopt a strategy of persistent and patient waiting, allowing the resonances to grow before deciding whether and how to share them with the client.
Lack of self-disclosure does not imply a lack of involvement or passivity; on the contrary, it is an expression of deep presence and willingness to be in full contact. It requires a high level of self-awareness from the therapist, ability to regulate their own emotions, and capability to distinguish when their reactions are information about the client and when they stem from their own history. Remaining curious about one’s own resonances allows the therapist to make more conscious interventions, which do not result from momentary experiences but rather from a deep understanding of what is happening in the therapeutic field. This approach gives the client space to independently experience and integrate their emotions, and enables the therapist to maintain clarity and professionalism.
Lack of self-disclosure and remaining curious about one’s own resonances is an important therapeutic skill, allowing to intensify the therapeutic process without unnecessary interference. By consciously observing one’s own reactions, the therapist can better understand the relational dynamics and support the client in their own exploration. This approach enables maintaining an open space for the client, supporting their autonomy, and minimizing the risk of unconsciously influencing the process. Ultimately, conscious non-disclosure is an expression of deep presence that permits the client to find their own path to change and integrate their experiences [8, 12].

The role of support person in building a relationship

An equally important element of building a therapeutic process is maintaining professional boundaries, which define how the therapist builds and maintains a relationship with the client, while ensuring the protection of both parties and the effectiveness of the therapeutic process. Main aspects characterizing this issue involve:
1. Clearly establishing the framework of the relationship, including defining roles. The therapist clearly communicates that their role is to support the client, not to establish personal, friendly, or romantic relationship. This ensures that the client knows what to expect, and the therapist protects themselves from unintentional transformation of the relationship. What is crucial in this process is confidentiality, strengthening the client’s sense of security, and helping to maintain the professional nature of the relationship [13].
2. Maintaining appropriate emotional distance through self-reflection and awareness of one’s own reactions, emotions, and potential transferences and countertransferences, so as not to identify oneself with the client or become emotionally involved in a way that could blur the boundaries of professionalism. Maintaining neutrality additionally allows the therapist to focus on the client’s needs without introducing their own unprocessed experiences or subjective opinions into the relationship [6, 7].
3. Emotional regulation and mindfulness techniques in therapeutic work encompass both emotional awareness (which is emotional regulation starting with recognizing one’s own emotions) and identifying them (which feelings arise at a given moment). Thanks to mindfulness practices, the therapist can better notice subtle emotional signals that are crucial for consciously managing one’s own reactions. Equally important are techniques of accepting the emerging emotions without judging them as “good” or “bad”. This approach enables the therapist to calmly accept intense experiences without the need to immediately change or suppress them, which in turn minimizes the risk of transference or countertransference [9].
Basic techniques of this type include:
– Re-appraisal: This technique involves re-interpretation of a situation that evokes strong emotions. Through reflection and attentiveness, the therapist can find an alternative perspective on difficult experiences, which enables a change in their emotional charge and a reduction in tension.
– Body regulation techniques: Relaxation exercises, such as progressive muscle relaxation or yoga, support emotional regulation by reducing body tension. Maintaining a balance between the body and mind is crucial for the therapist to be fully present and respond appropriately to the client’s needs. Mindfulness techniques and emotional regulation are essential therapeutic tools, enabling the therapist to participate in the therapeutic process fully and consciously. By increasing self-awareness, emotional stabilization and modelling as well as healthy coping strategies, the therapist supports the client in achieving deeper, transformative changes.
4. Establishing temporal and spatial boundaries builds a sense of stability and security. Session time and meeting frequency, establishing a fixed session schedule, and work rules, help maintain the structure and stability of the relationship. The physical and emotional space where therapy takes place, provides a safe container for the change process, allowing the client to explore their own experiences without violating the therapist’s personal boundaries. In turn, professionalism with clear and precise communication, which require using language that is clear, understandable, and free from excessive personal disclosure, help maintain the appropriate distance.
5. Maintaining ethical standards by adhering to the code of ethics with its current norms, define acceptable behaviors as well as those, which may harm the therapeutic relationship. Being sensitive and attentive to the reactions and signals that may indicate boundary crossings, calls for appropriate response and maintaining a balance between support and protection of the client’s autonomy [14-17]. Maintaining professional boundaries can therefore be considered a comprehensive process that encompasses clear role definitions, supporting appropriate emotional distance, structuring the time and space of the session, professional communication, and adherence to ethical standards. Through these activities, the therapist creates a safe, structured space, in which the client can freely explore their emotions, while both parties protect their boundaries, promoting an effective and safe therapeutic process.
The theoretical foundations for building rapport with the client described above can, to some extent, be used to develop a workshop program, which influences the participants’ awareness, and provides a foundation for further work on self-awareness in professional relationships, preventing iatrogenic errors, and fostering more satisfying relationships with the clients. In addition, they can matter in a sense of meaning and experiencing oneself as someone who not only provides professional care to the clients, but also brings relief and support at the psychosocial level.

Disclosures

This review paper received no external funding.
This review paper obtained approval of the Bioethics Committee, with consent number: 118.0043.1.335.2024.
The author declares no conflict of interest.

References