Ask yourself these questions to decide if you need psychotherapy.
This article is for the people have landed on this site looking for psychotherapy, and are wondering if psychotherapy is what they need right now.
Here are some questions (in no particular order) to ask yourselves. If one or more of your answers is a “yes”, it is probably a good idea for you to speak to a psychotherapist.
Your doctor / psychiatrist / teacher or other professional advises you to get therapy.
Your loved ones encourage you to seek therapy.
You are looking for answers about your inner experience.
You are experiencing a difficult milestone in your life: leaving home, getting married or divorced, having a child, being diagnosed with illness, migration, etc.
You find yourself in a difficult or abusive relationship at home or at work.
You experience physical reactions that you cannot understand: like panic attacks, crying attacks, rage.
You are having thoughts that are churning in your mind.
You suffer anxiety: social anxiety, phobias, paranoias.
You’re not sleeping well: not able to get to sleep, waking up in the middle of the night and not getting back to sleep, not able to wake up, sleeping all day, having nightmares.
You have an overwhelming feeling helplessness.
You have an overwhelming feeling of guilt. You blame yourself for many things.
You harm yourself physically.
You have suicidal thoughts and/or plans.
You are addicted to substance.
You are addicted to a behavior: working, shopping, internet use, porn, sex.
You are on antidepressants, anxiolytics or antipsychotic medication, and are thinking of reducing these.
You obsess over certain activities. These activities preoccupy your life, affecting your work, and family life– like work, sports, collecting certain things, hoarding things.
You have problems eating: obsessive thoughts about eating or not eating, bingeing, throwing up after eating, thoughts of starving yourself, feeling anxious around food, not able to enjoy food or the eating process.
You have issues having sex.
You suffer pain and aches that your doctors cannot find physical cause of.
You are having problems working or studying, and feel like you’re about to burnout.
You are socially isolated and / or feel very lonely.
You have lost a parent / family member or two for over a year and have not got over the loss.
You had had difficult childhood experience of abuse, neglect or abandonment.
You have been sexually abused in your life, and have not worked through this experience with anyone.
You have difficulty remembering parts of you childhood, and you suspect trauma.
You’ve encountered a traumatic event that was threatening to your life or the life of someone else.
You cannot feel or identify your emotions.
You see, hear of feel things that are not there.
You or a loved one suffer chronic physical ailments or disability.
You or a loved one have been diagnosed with terminal ailment.
Your children are suffering from poor grades, ADHD, stress or are suicidal.
This is not a comprehensive list, although it does cover issues that I deal with in the psychotherapy practice.
Understanding cannabis use, it’s effects, addiction and trauma.
Gabor answers questions regarding the use of Marijuana (Cannabis). He discusses addictions to some drugs, and how these are relative to the effects of legalized narcotics like tobacco, alcohol and prescription drugs.
Important point he made is on the effects of drugs on developing brains of young children and adolescents, putting a spotlight on prescription of drugs to children.
As a therapist, I fully appreciate his emphasis on psychological trauma as the root cause of addictive behavior. He tells us that the medical profession should be more aware of trauma.
This lecture is presented in this site because it is a good argument for going to psychotherapy sessions that involve working through emotions and childhood traumatic experiences.
Gabor Maté’s message is an important one. As I write this reflection article, I am myself experiencing being in a situation which is teaching me an important lesson: I am forced to take a 5-day unexpected break from a hectic schedule which I had created for myself. I had an accident. I fell from a deep flight of stairs, and escaped with injuries that could have been much worse. Sitting at home nursing a swollen brow and black-eye, I am reflecting on how, for the last couple of months, I had wanted this time off but did not have courage to put appointments aside. I did not want to disappoint other people.
This accident was no accident, but a warning. A therapist myself, I knew what was going on in me, but I really thought that the rest could wait. Wrong I was.
It is so easy to fall into the trap of self denial, because we are programmed to be so. Maté’s lecture, “When the body says no — caring for ourselves while caring for others”, hits the nail in the head.
On premature aging due to stress of taking care of others
2:30 DNA studies show aging in people who live under stress.
Preoccupation for the needs of others, while neglecting the self as a risk factor for chronic illness.
4:20 A story of the personality of a woman who has breast cancer. How she worries about her husband’s emotional state rather than dealing with her own illness.
5:31 He reads obituaries of people who died too soon, to illustrate the self-sacrificial and self-denying behavior of people who have died from chronic illnesses.
Dealing with Anger
7:50 The dangers of suppression and repression of healthy anger leads to autoimmune disease and cancer, while going into rages, which is the polar extreme leads to heart disease.
The healthy way to deal with anger is to notice it, accept the feeling and talk to someone who is willing to listen about your anger feelings. Healthy way to deal with anger is crucial to health.
9:55 Mate describes a study from Australia of married women. Those that were unhappy in their marriages and could articulate them were better off physically than those who suppressed their unhappiness. The issue was not about happiness of the marriage but the ability to express the anger underlying.
Hanging on to roles society imposes on you, trying to please everybody, while forgetting to take care of your health can cause deterioration of health and death.
We cannot separate mind from the body.
14:05 Mate explains to us about chronic illness and the current medical attitude towards these illnesses.
We cannot separate the individual from the environment
16:11 We are shaped by the environment. Environment is not only physical, but also the psycho-social environment. This means that the environment includes the people we live amongst.
To illustrate this, he cites studies where children whose parents are stressed are more likely to get asthma in polluted environment and other illnesses. This is known to be directly as a result of stress since asthma drugs are stress hormones themselves.
We cannot separate ourselves from the mental states of others in our society.
Talking about anger to someone is important reliever of stress
19:10 Studies of breast cancer patients in Australia found that having a stressor in life AND being socially isolated made the subjects 9x more likely to have cancer. Mate explains that connection with another person, talking to others about feelings of anger is instrumental to maintaining healthy life.
Stress from anger is not only mental, stress is also felt in the body. In short term, stress hormones help to escape, long term stress causes chronic ailments.
ALS is a neurological motor neuron disease, which strikes usually healthy people, and is fatal. Mate found these patients to have a personality tendency of denying their negative feelings, denying the experience of the self, while having the overwhelming need to always be there for others-
27:03 He talks about the story and personality of Lou Gehrig. Gehrig’s name is the name for ALS. His personality of selfless ambition and helpfulness is typical of what Mate considers a personality that is typical of patients wit ALS. Lou Gehrig had childhood trauma from growing up a child of an alcoholic.
These are caused by unconscious patterns. Not the fault of the patient’s themselves.
Unconscious self-denying behavior is learnt from infanthood.
19:30 Mate tells us his own story of how unconscious factors affect how he too has a tendency of self denial while trying to protect his mother.
Infants pick up on the stress of the mother and other caregivers. Infants learn to suppress their own pain in order to maintain a relationship with its care-giver. This infantile suppression becomes a memory that is recorded by and stored in the body. It is called trauma.
Making oneself lovable is done by suppressing feelings and denying own needs.
Mind and body are inseparable.
Personality patterns are learnt from infanthood. These patterns translate into physical illness.
36:00 Newborn need to establish these patterns to maintain attachment to adults.
Emotional centers of the brain are attached to the hormone system, and nervous system are connected to the immune system. These systems are connected.
38:40 Mate explains the phenomenon of “gut feeling.
How and why we give up our authentic selves as children
Children read and respond to gut feelings intuitively. Children are born with ability to intuit body language of adults accurately. As we get older, we begin to suppress this gut feelings, and rely on intellect.
41:40 There are 2 great needs of children. One is attachment to the care-giving adults. The other need is to be authentic. This is a need in order to function as an individual human being. In situations where we, as children have to sacrifice our authentic self, because this authentic self endangers the attachment to our parents, leads us to a pattern of having lost touch with our needs and feelings.
Our problem as adults is that we still stick to this need for attachment.
42:48 The Heart-brain Connection predictive activity.
Hence our emotional states is connected to our physical health.
Healthy anger is about knowing your boundaries and expressing it
44:45 Mate demonstrates what boundaries are and how boundaries can be breeched. He explains that healthy anger is necessary for us to communicate to the other that our boundaries have been crossed and to back off.
Immune system is linked to our emotions
The role of our emotions is boundary integrity. To keep out what is unhealthy, and let in what us enriching. The job of the immune system has similar roles.
Autoimmune disease is a way of the body attacking itself.
To prevent illness or overcome illness, we need to exert who we are and to say, “no”.
Saying “no” may trigger fears about attachment, but we have to remember that we are adults.
If you are caring for others, you must demand support also for yourself. Ask yourself and reflect on this question: in what situations in your life is it difficult for you to say, “no”.
Psychotherapeutic change is observable. Noticing the progress of the client is an important aspect of therapy.
An important aspect in the work of the therapist, is to track patient progress. In my practice, even if I do not mention to the patient, I look for signs at every session.
The healing process in psychotherapy is often a subtle one. Meeting the patient every week, it is possible for the therapist to overlook these changes. Therefore, I give special attention to looking out for the signs.
Importance of looking out for the patient’s progress and change during therapy sessions
It is important for the therapist to be alert to change. Patients are normally oblivious to the subtle changes in their own personality. Left on their own, individuals may start doubting their new sense of being (due to persistent introjects / resistances).
Noticing the client’s change and progress is helpful to him/her. The therapist, in bringing attention to the development of the patient, helps the patient to integrate fully with this new attitude or behavior, through:
acknowledgement of the perceived change,
appreciation of how the change is impacting the life of the client,
understanding of how the change is developing and meaning making,
assimilation of the experience, i.e. how it feels to exist with this change.
Some signs of change observable in the patient during the course of therapy.
There are many signs of change. Here is a brief description.
Change in how the patient makes eye contact, makes facial expressions.
Change in posture, dressing, hairstyle — not the usual change of styling, but when the client comes in, and his/her aura feels different.
Change in topics brought up in session — most individuals bring up a kind of focus topic (like work or kids…). I’d notice a change when the topic is suddenly no longer interesting to talk about, or when another becomes figural. Generally, when the topic becomes more about the experiences of the self, it is progress.
Change in the client’s emotional vocabulary.
Client’s own account of perceiving new feelings or losing anxiety . Especially after holidays, the client reports that certain old feelings of anxiety around the festive season is no longer felt.
Client making new decisions. This applies to clients who have difficulty doing so.
Client reducing medication (esp, meds that have been long time prescribed), or reports having alleviated physical symptoms.
Client reports that children / spouse, etc are “doing better” (usually relationshipwise).
Note that these changes may not mean that the goal of therapy is reached. Change indicates that the therapy is in progress, and the patient can look forward to more enrichment from the sessions.
This article explains the use of Gestalt Therapy for crisis intervention with patients who are suicidal. The article by Young & Lester (2001) , provides for good information on the topic. I shall list the following points presented by the authors.
Gestalt therapy is an ideal method for dealing with crisis situations. This is because of the methods focus on the here-and-now and being present for the patient. Working with suicidal patients in crisis, being empathic and listening is everything. Accounts from patients in dire situations are filled with expressions of loneliness and helplessness. Hence being with someone who is actively listening without judgement is precious.
This is an article for persons who need to work with and help suicidal individuals.
I am putting together notes from seminars attended and literature read on the topic of working with people who are imminently suicidal. I hope that the information is useful.
Unless one is familiar, or has come to terms with one’s own thoughts of suicide, one cannot really put him/herself in the shoes of a person in the situation of wanting to kill him/herself. The below video of a talk by Kevin Briggs is a good introduction of how to talk to suicidal people.
How to spot a person who is in danger of suicide
Often when a person is determined to take his/her own life, he/she is alone. Being able to spot a person (family member, acquaintance, friends or other loved ones) in a pre-suicidal situation is life saving.
Ringel (1953) writes that pre-suicidal syndrome is characterized by:
Narrowing of the ability to act
Narrowing of the emotions
Narrowing of the perception
Narrowing of the relationship capacity
Narrowing of the seeing value (or positivity) in the world
Increase of the self-directed aggression
Increase of the imposing suicidal fantasies
Other signs of Suicidality
Feelings of helplessness and hopelessness
Feelings of being offended / hurt
Unbearable mental pain
Desire to impress or punish others by suicide
Long-lasting sleep disorders
Affective and aggression congestion
Lack of resources
Poor impulse control
Some Observable Signs that a Person is Seriously Contemplating Suicide :
there is persistent suicidal thoughts.
there is no distancing from the suicide ideas.
the person has a suicidal plan — take appropriate action when weapons or medicines are easily accessible or if the plan involves the patient going to a place no one can find them.
the person sends out recognizable farewell signals such as letters, giving away objects, cleaning up unfinished businesses, creating orderliness.
Send the Person to the Hospital if…
Call the ambulance when, the person in danger:
clearly announces suicide
is not believable
is not conversant
denies intention to commit suicide, however, the external circumstances clearly indicate intent to commit suicide (severe previous attempted suicide in case of continuing stress situation, depression with hopelessness, concrete suicide preparation, details of relatives).
How to Act in the Presence of a Person in Danger of Suicide
Stay calm, breathe.
Try not to be hastily comforting. Comforting is generally not effective.
Emphatically empathize instead of admonishing.
Concretize rather than generalize. Ask the person specific things, and not talk about hypothetical things.
Take the problem mentioned seriously. Do not downplay the problem. Avoid negating the person by using the words “no” and/or “but”. If unsure, say “yes”, “uh huh”.
Listen quietly with understanding, instead of judging and commenting.
Carefully gather information from the person instead of investigating, questioning, analyzing.
Holding a Conversation with a Suicidal Person in Crisis
Be understanding to the person in his / her specific situation, especially in the situation that led to suicidal behavior. Ask, “How was that exactly, can you tell me more about it?”
Relate to this event. Ask, “That’s a situation where you thought of suicide?”
Speak openly when addressing suicidality. “You thinking of ending it all?”, “Can you tell me more about it?”, “I am interested to hear about it.”
Talk about the relationship and interaction in the here-and-now between you and him/her. Ask, “How are you feeling with me now, during our conversation?”
If you feel touched, or have warm feelings, share this with the person.
Handling Crisis Intervention by Telephone
When someone on the other line of the telephone is in danger of taking their own lives consider the following:
Stay calm, breathe.
Talk directly about the problem. Encourage him/her to describe the reason for the call. Talk about what concrete help is needed.
Discuss what can be done, what realizable help is possible.
Invite the person to a face-to-face conversation.
Hearing the person out, let him/her talk. Be accepting of what you hear. Respond empathically to sounds of distress. Withhold any judgement, negation (saying “no”, or “but”), blame or preaching.
Discuss clearly the next steps about what can be done, if applicable.
Please remember this…
You are in a position to be there for someone in his/her darkest moment. It is a privilege to be there. Be patient and listen with an open heart. Accept what you hear as the other person’s truth. Be present. Focus on your own breathing. If you feel touched, sad or thankful for the contact that you are having, tell it to that person.
Wait for the appropriate time to bring this up…
Even at moments closest to committing the act of suicide, the person is still ambivalent about his/her death-wish. Verbally acknowledge to this person, that something in him/her still wants to live.
“Being with you right now, I’m hearing (or feeling, or sensing), that a part of you really wants to live. “
More Notes on Conversation with Suicidal Persons in Crisis
Take every suicide note on the phone seriously A person tired of life is still talking. He/she is still wants to live, otherwise he/she would not be talking to you.
Suicidal behavior is often an attempt of that person to communicate with somebody. It matters not who you are, you are an important listener.
Suicidal remarks must trigger active listening.
People in distress often see black and white. They respond better when you communicate with them clearly, in short, simple language.
The dangerous moments of a suicidal crisis last only a few hours. Do not fear that it would be too much for you to withstand.
If you are someone who is in touch with your own suicidal thoughts and desires, you are more likely to cope with the suicidal aspirations of the other.
Show concern, but do not be afraid of the words and intentions of the other.
Avoid anxious-well-meaning paraphrases. Instead of saying “suicide”, say, “You want to take your life”.
Suicidal callers ambivalently waver between life and death. Talk about this ambivalence and reinforce it. This will help the person to remember that part of him/her still wants to live.
Call the person by the name, in order to develop a personal relationship.
The suicidal person before you has the right to make personal demands and say absurd thing, even though it might get on your nerves.
Talk to the person in the way he/she wants to talk to you. Mirror the person’s kind of talk.
Do not let yourself be drawn into his/her feelings or thoughts of hopelessness. Ask instead about these feelings, and the memories, etc. behind them.
Avoid asking “why” – type of questions. Similarly avoid asking for reasons. These questions are interrogatory.
Encourage mini-actions. “would you like to meet up (if in phone conversation) or “should we have a cigarette?”
Ask about other people who are still important in the person’s life. If there really is nobody, offer yourself as such a person.
Encourage the person to develop fantasies about his/her future, but
do not do it for him/her.
Do not allow his/her conclusions to convince you like “why I have to kill myself “. Turn it around to, “there is still time to do such and such”.
Tell the other how glad you are to talk to him.
Try to reach an agreement that the other before he hurts himself to call you again.
Do not forget, that despite your best efforts, some still would want to exercise their right to take their own lives. Keep this in mind.
Presenting a psychotherapy case study about how psychotherapy treatment heals.
The full potential of psychotherapy is healing. The healing work enabled through psychotherapy is holistic. This means that psychotherapeutic healing involves the biological, psychological and social aspect of the patient.
Psychotherapy is a complement to medical treatment
Unlike medical professionals who traditionally focus solely on the body while ignoring the social and mental state of the patient — that is now changing in, thankfully– psychotherapists pay attention to the entire person. Particularly true for chronic diseases like cardio-vascular heart disease, medicine and medical procedures only try to remove the symptoms. Psychotherapy helps the patient to work through stress that resulted in the symptoms in the first place, manage behavior to help maintain lifestyle changes, and work through coping with the depression and trauma of having been diagnosed.
Psychotherapy is a more intensive form of counseling or psychiatry
Psychotherapy is a profession that is often confused with others, like counseling, psychology and even psychiatry. To really briefly describe the essential focus on each field of mental health I would say that counseling works on problems of daily existence, daily functioning at work and play, or problems created from behaviors that do not support daily function. Psychology is a broad field of work that researches human behavior and responses to situations. Psychiatry considers that which is emotional and behavioral to be biological, and deals with these issues with medicine or medical procedures.
The way to explain the gestalt therapy attitude towards healing is with this Chinese idiom:
“When cutting grass, the roots are not pulled out, when spring arrives, the grass grows back.”
We can see this in ourselves and in others. Our emotional problems, issues with relationships, problems with work, health problems tend to show repeating patterns. Sometimes we even see these patterns in our parents or in our children. Oftentimes we try to fix the problems. Often another problem of a similar nature surfaces. This is the metaphorical grass mentioned in the above idiom.
If you do go for psychotherapy, your attitude as a patient is to work towards identifying and removing the roots. It is not always painless, but a therapist who is well versed in the work can walk you through it.
The tool of Psychotherapy is dialogue
The term “talking cure” was coined by a patient of Breuer, Anna O, the first recognized patient of psychotherapy. Talking is not the right word. Rather I would used the word, dialogue. Gestalt psychotherapists like myself work with verbal and non-verbal communication. We can work with persons who do not talk or are not able to.
Psychotherapy works through affects and unconscious activity through dialogue and expression of these thoughts and emotions. The goal is to relief stress from painful emotions, by working through traumatic memories, painful thoughts, and difficult emotional experiences. Through working with the unconscious, awareness is formed and stress is relieved.
Relief of stress from psychotherapeutic treatment and health consequences
The relief of stress creates a change in the neuro-chemical balance in the brain. In turn, the hormonal system is readjusted. This changes and strengthens the immune system and cardio-vascular system. Balance in the immune system reduces risk of cancer and even aids in healing cancer, while reduced stress to the cardio-vascular system reduces blood pressure and heart attack & stroke risk.
Psychotherapy heals the body by causing a readjustment of the neuro-chemicals and hormones in the organs. Patients can feel this effect after an effective session of psychotherapy.
What one gets from Psychotherapy is a holistic benefit: empowerment to build relationships, energy for work, study and play, and inner peace.
What is the consequence of this relief of stress? Let this interview of Bruce Lipton explain to you how relief of stress as a result of dealing with the unconscious leads to physical healing and prevention of serious diseases. Lipton explains how medical problems are influenced by epigenetics rather than genetics. Unlike genetics, which we cannot change, epigenetics describe the expression of genes. Expression of genes is determined by environmental and situational factors that we face in our daily lives.
Lipton explains that belief can determine outcome of treatment of illnesses, and how this translates to the concept that our consciousness affect if we get ill or get cured.
Healing in the psychotherapeutic session
I focus on the emotions and the connected thoughts that arise. The opposite is also important: memories and even fantasies are investigated to examine the underlying emotions. The integration of the person with his/her emotions and thoughts through dialogue and behavioral experimentation in the psychotherapeutic session leads to chemical change in the neurological system of the patient.
This is a case study of a patient who came to therapy because of experiencing stress at his workplace. He was often on sick leave for chronic migraine, hemorrhoids and even un-explainable occasional hearing loss. Close to losing his job, he attends therapy. Only after weeks of treatment, did he realize how he, as a young child, was affected by traumatic situations at kindergarten and later elementary school. His home country was governed by a communist regime during the time of his childhood in the 80s. He had survived his childhood years by forgetting how frightening and lonely the situation was, while secretly hoping that he would be sick so that he could skip school.
This client’s psychotherapy treatment was about working through the trauma. With time, we worked together integrating his memories with awareness of which emotions belonged to the past, and what is no longer needed in the present. One of these was the realization that he no longer needed to “get sick” to skip work. He took breaks, sometimes weeks of non-paid vacation. He learned to regulate his spending, so that he could breathe easy when he took those breaks. Talking about and expressing painful emotions allowed him to release energy that he had bottled up and forgotten all his young life. He became more aware of tension in his body, and started doing yoga. Soon after, he stopped taking medication for migraine. The patient realizes that his path to healing is life-long. Along the way, he was able to find love as well.
The Lasting Effect of Psychotherapy
Unlike taking a pill to regulate emotions, neurological changes brought about by psychotherapy are subtle and lasts the lifetime. With regular sessions, these changes snowball into observable physical improvement. Unlike medication, treatment with psychotherapy does not leave behind negative physical side-effects, as can be seen with antidepressants.
For reasons that Psychotherapy is chemical-free, it is a treatment much needed for children, teens, young adults, and people hoping to be parents.
Through working with the psyche, psychotherapy enables the patient to better function in work, play, sex and relationships. As the patient becomes more self aware, he/she also becomes more aware of his/her relationships. He/she ultimately functions better in life. The effect of psychotherapy achieves what one looks for in counseling, with the added benefit somatic healing.
Just as there exists many schools of psychotherapists, there are, of course, different opinions on this subject of healing. The article written reflects my own work.
Obsessive Compulsive Personality Disorder explained and treated with Gestalt Therapy method.
The DSM V describes obsessive-compulsive personality disorder (OCPD) as a pervasive pattern of preoccupation with
mental and interpersonal control.
Individuals who present phenomenon of OCPD give up their flexibility of behavior and thought. They become “closed up”, showing lack of openness to the environment around them.
The consequence is that of being in-efficient in doing daily tasks, since the preoccupation is on distracting details, rules and schedules, that leaves the main task undone. The quest for having tasks done perfect also leaves task unfinished. While everything takes longer to complete, there is obsession with work and productivity, leaving little energy left for leisure activities and relationships. Relationships suffer because there is a tendency to be overconscientious, and inflexible about matters of ethics. Many individuals with OCPD tend to have religious or ideological stance, that they hold on to. They may also have a fixed idea of how things should be done, and would not delegate their work to others, unless the others follow his/her way of executing the tasks. Some persons show tendency to hold on to unnecessary objects. Similarly there is a tendency to being miserly. A certain feature of this personality style is the display of rigidity and stubbornness.
OCPD is differentiated from Obsessive Compulsive Disorder (OCD) by the by the presence of true obsessions and compulsions in OCD.
Obsessive Compulsive Personality Disorder Explained with Gestalt Therapy
Looking at this condition through gestalt therapy lens, we can appreciate the complexity of the treatment process. In seeing the process at each stage and the resistances of the individual towards change, we can follow the clients’s path with more understanding and patience.
At the sensory stimulation phase (the initial phase): one’s own needs are ignored. Habitual behavior and thoughts take the place of present needs. Feelings that arise in the foreground become interrupted by background noise of routine activity. The patient may find difficulty articulating needs or accessing emotions. Difficult emotions are avoided. In place of this is the need to continue habitual behavior.
At this phase of treatment, focus on arising emotions is the work. Often the patient is able to recount difficult life situations, but the narration lacks emotional content. The therapist’s job at this point is to support the patient in embodying the denied emotions, instead of blocking them out with compulsive thought.
At the Orientation phase: There is seeking of external rules. The self has to be perfect, and be right. “I must do it right”. “I must check this…”
There is a sense that being not perfect may lead to loss of love, rejection and helplessness. Control against these feelings are directed towards the external environment.
Experiment with words, making statements and dealing with projections (e.g. other people will judge me if ….) plus dealing with emotions is the work at this stage.
At the Action phase: This is the phase that occurs when the individual is guided to act on behalf of his/her needs rather than acting on his/her impulses. This can bring about anxiety. OCPD actions are acts out of fear of helplessness, and behaves so as to avoid the possibility of situations that leads to helplessness. This means controlling and perfecting the environment, and external self. Ultimately nothing suffices.
Therapy at this phase brings to light the anxiety that arises. There is also projections (attributing thoughts of the self on other people) and retroflections (holding the self back, or blaming the self) that need to be worked through.
At the Assimilation phase: At this phase, the individual would have tried to change his/her behavior. This is possible through practicing will-power, or having behavioral-style therapy. However, attempts to change behavior get quickly sabotaged by introjected messages (like “this is wrong”, “it will not work”) that lead to the individual rationalizing the attempt, denying the point of attempting change, feeling contempt for the effort or try playing down the problem. This is the reason why in gestalt therapy, we are aware that behavior modification attempts alone does not resolve the issues of OCPD.
At this stage, it would be better to check with the patient about his/her introjects, and feelings of guilt or shame that may arise from taking appropriate action.
At the release phase: Let’s say that the patient has managed to overcome the first four phases, the next tendency would be to hold on to the identification of the self with OCPD. There need would be to not let go of the habitual thoughts and action, to see them as the “right thing to do”. This is a protection mechanism against the grief that can arise from feelings of loss and feelings of loneliness.
At this phase, the patient may seem very sad or look depressed, angry. He/she shows strong emotions. The therapist supports the patient by being present and acknowledging the client’s difficult emotions, and helping him/her work through the mourning process.
The treatment process in Gestalt therapy for OCPD, when done in it thoroughness, with the above phases worked through requires a good amount of patience within the psychotherapeutic alliance. At each phase, difficult emotions need to be acknowledged and processed.
Treatment of symptoms arising from personality disorders take time. Patience is essential for both therapist and patient. Where dealing with loss is concerned, the mourning process is an important, positive step to healing.
Physical appearance is usually thin, haggard, not enjoying, gray, tensed.
The emotions include fear, anxiety, loneliness, helplessness, defiance, vulnerability. Initial emotionality may look flat, and restrained.
Psychosomatic reactions may include stomach and gastro pain and symptoms, constipation, circulatory system problems (e.g. myocardial infarction).
Polarities to work through are :
Powerfulness – Helplessness
Fear – Aggression, Anger, Bitterness
Control – Chaos
Obedience – Defiance, unruliness
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Anger, H. (2018) Gestalt Diagnostics. Private Lecture at the Sigmund Freud University, Vienna.
My work in psychotherapy is about healing. It is in my foreground every minute I work with a patient. Oftentimes patients do not realize that in our therapeutic conversation, there is an underlying therapeutic process. This is because the therapeutic dialogue is, a conversation with another person, but different. The phenomenon of a relational gestalt therapy (my school of study) dialogue is mostly felt, tasted and sensed, before it gets intellectually understood.
Subtle is the therapeutic process not
When we go for therapy, we may experience no big change for weeks or months. We may talk about the same things in circles before something happens: an insight, an understanding, a gush of emotions, a relief from tension. When and how we get to this point in the therapy is usually not foreseeable.
Case Study of healing process in psychotherapy
I recount a case study of a journalist named Mary (not her real name), who came to therapy because of stress due to conflict with her colleagues. Her goal of therapy was to reduce the stress and panic feelings when she is at work. She feared that she may become too emotionally unstable to go to work because of this. For months, Mary talked about her work environment, the colleagues and tried to understand the incidents that triggered in her deep emotions. She also talked about her work, which she calls “her passion”; to remind women of their rights through feminist writings and stories. More weeks went by, and I began to wonder myself if her process was heading anywhere. I stuck to the process of her work, which with time, saw Mary more comfortable with expressing more difficult emotions, especially feelings of vulnerability. Baby steps. One day, she revealed that she had been sexually assaulted by a group of college mates and that she had kept this incident a secret for 20 years. She was able, after 14 months of therapy, to talk about it in session. Along with this revelation came a flood of feelings: resentment, shame, guilt, vulnerability, frustration, anger, grief, and also thankfulness. At one point, she was even angry at me for having initiated her emotional unravelling. For a couple of weeks, she said that she could not work. She, however, recovered from this.
Mary transformed. She had been afraid of coming to terms with a painful past. In so doing, she re-lived her inner feelings of resentment, frustration and anger towards others and herself in her workplace and even in her writings. While these feelings helped her to write powerful articles, it also caused her to build walls between herself and the society in which she is in contact with. The conflicts left her stressed out and panicky at work. She was helpless against the emotional turmoil. Working through of her traumatic experience, she unleashed the source of these painful feelings. Through this process, Mary was awarded choice. She could tap on these feelings as motivation to write and guide others. She is, however, not bounded to these feelings anymore. She finds inner-calm — which she said “had always been there”, but she did not realize it– in her social context. With time, she was able to build more allies. Panic feelings were soon past.
So what is healing to me in the psychotherapeutic sense?
Mary’s healing was a journey towards self-awareness and growth. The time, energy (and, not to forget, money) she had spent in therapy rewarded her with freedom from unconsciously re-living a traumatic past.
Healing in psychotherapy takes place when the patient, like Mary, is able to grow and transform through insight and experiencing (and sharing) of feelings. This healing provides the individual with choice. This concept of healing is unlike that of conventional thought of “healing diseases”, which strive to remove the disease. In psychotherapy, mental and emotional issues are not to be judged as bad and removed; but understood. Depression, anxiety, PTSD and personality disorders aren’t “diseases to be cured”. These are opportunities for personal growth.
The healing –in a way described in this article– achieved in psychotherapy, is permanent. What Mary has gained will be with her for life, and she will continue to grow with it.