How does Psychotherapy Work? General Systems Theory and Synchronization

How do we explain the transformative work of psychotherapy? The therapist and client of the psychotherapeutic encounter do not exist in an isolated bubble; both exist integrated with the environment we call the field. The field encompasses the biological, psychological, physical and sociological environment in which the therapist and client are embedded. The psychotherapy situation is in constant flux with the field. Psychotherapy is an open system.

Change in psychotherapy is complex, non-linear, and perceived as organic. The psychotherapy profession has long understood this concept, which differs from the paradigm of the broader field of the medical model of healing that views the patient as a unique entity disconnected from the environment.

The medical model approach considers the patient and their issues unique to the individual, often ignoring the environmental contribution to the patient’s suffering. The patient sees the medical professional and gets treated for their symptoms. Usually, the patient is offered medication to relieve symptoms, and healing is expected to happen spontaneously. Sometimes healing does not occur, but just an alleviation of suffering. Diagnosing and treating the patient this way is the mono-personal approach to therapy.

The figure below illustrates the different dimensions ‘ways of seeing’ psychopathology (suffering and symptoms), treatment and diagnosis in therapy. The relational attitude is adopted by contemporary psychotherapeutic schools, where the study, focus and treatment is experienced in the therapeutic relationship.

Three different attitudes and focus on treatment and diagnosis: 1) the mono–personal attitude where the client and their suffering is attributed to the individual alone disregarding the environment, 2) the relational where the client’s suffering is encountered and treated within the therapeutic relationship, and 3) the field theory, or the aesthetic attitude where the client is treated as a co-creator of the field.

The field theory is unique to Gestalt therapy. Contemporary Gestalt therapists have attuned themselves to investigating psychopathology and therapy even further by looking at the aesthetics of the co-created field.

A Gestalt therapy perspective of psychopathology is necessarily grounded in a field epistemology. The field concept enables us to understand experiential phenomena as being emergent from a dimension that cannot be reduced to the individual, or to the sum of individuals at play. Every relational situation actualises a new, original field. Subjective experience is not the product of a single mind or isolated individual; it is an emergent phenomenon of the actualised field.

Francesetti, 2015

The co-created field encompasses the client and therapist in their bio-psycho-social environment and is unique to the encounter. Read also: Notes on Field Theory in Gestalt Therapy. Field theory renders the therapeutic encounter an open system. Neither is the client treated as an individual nor is the therapeutic situation treated as separate from the outside world. The field theory includes everything relevant to the here-and-now of the therapeutic session. Attunement to the field involves noticing and focusing on the atmosphere of the therapeutic situation. Change is effected through the field. Movement in the field facilitates meaningful psychotherapeutic change and transformation.

As we consider the concept of the co-created field in psychotherapy, we will also realize that psychotherapy is an open, dynamic and complex system.

General systems theory

Notes on how psychotherapy works based on dynamic systems theory or general systems theory.

General Systems theory is an interdisciplinary practice applied to many fields of sciences, including cybernetics and biology. The concept was published in 1934 by Austrian biologist Karl Ludwig von Bertalanffy (1901-1972), who proposed that the classical law of thermodynamics, which applies to closed systems, has limited relevance to open systems (Wikipedia, 2020).

The phenomenon of Synchronization

The videos below demonstrate the phenomenon of synchronization. Unique objects with their own stable pattern, influence the co-created environment, causing their own patterns to change.

Two metronomes are placed on a common base. The metronome on the left is set at 192 beats per minute. The one on the right is set at a slightly lower rate. The metronome pendulums are initially out-of-phase. The two pendulums oscilate in phase due to conservation of momentum and coupling via the base. A true physics masterpiece!

This is another example with the use of several metronomes, each with their own temporal settings. After a while, all metronomes sync together.

This video illustrates the temporal synchronization of metronomes coupled via a common ground plate. This (well-known) phenomenon goes back to the observations of Christiaan Huygens (die Pendeluhr: Horologium oscillarium, 1763). Timeline: 0:00 – Setup and “What’s going to happen?” 0:21 – Synchronization from arbitrary positions 1:04 – Re-synchronization after disturbance

Synchronization happens in biological systems. All biological systems are attracted to the field which guides their growth and movement.

We know a lot of factual information about the starling—its size and voice, where it lives, how it breeds and migrates—but what remains a mystery is how it flies in murmurations, or flocks, without colliding. This short film by Jan van IJken was shot in the Netherlands, and it captures the birds gathering at dusk, just about to start their “performance.” Listen well and you’ll be able to hear how this beautiful phenomenon got its name.

Psychotherapy and General / Dynamic Systems Theory

Psychotherapy is an open complex system, like all biological systems and groups. Open complex systems are self organizing, and creatively adjust to their environment. They dynamically change with time. This change is continuous and non-linear.

Open systems oscillate dynamically and try to find stability. Transformative change involves the process of deconstruction, reorganization and reconstruction. In psychotherapy, pathos or suffering is sensed, grasped, and brought to the surface. The client learns to frustrate old patterns by attempting behaviour change and meeting the therapist at the contact boundary. This process can happen through experimentation and (sometimes accidental) confrontation of transferences.

The client’s “pathological” situation is an autonomous pattern formation, which the client would like to change. This pattern is, however, a stable pattern that has developed through life experiences and trauma. It is a meaningful pattern, though often dysfunctional that the individual has adapted to since childhood. In psychopathology, some patterns have more severe consequences for the person, like obsessions and compulsions, and anxiety. In less severe states, the individual suffers setbacks in relationships due to personality and unstable attachment styles. This pattern is played out in therapy and felt in the field. The attuned therapist can grasp how the therapy situation impacts them in the co-created field with the client.

In therapy, the client’s pattern is challenged. The challenge brings about resistance. We can say that the old pattern repels this challenge. The client may get used to this challenge and change. This may manifest as the ability for the client to attend therapy as a routine. This initial influence of therapy on the client is the first -order change. Here lies a comfortable synchronization in the field.

Transformation happens at the second-order change. This process takes time. The second-order change is the lasting permanent change of the pathological pattern. Second-order change requires the deep modification of the system’s way of functioning. In Gestalt therapy, this is a phase of change called the impasse. Read also: Gestalt Theory: 5 Phases of Therapeutic Change. When the client can stay in therapy long enough to find themselves in a situation of the impasse, which is often an uncomfortable state, a transformation phenomenon happens. At this stage, there is a re-synchronization, and the new pattern becomes stable. The client experiences a shift.

In trauma therapy, the synchronization that happens in the therapeutic encounter is also a physiological one. The therapist provides the client with a safe space and a centred presence in the therapeutic field. The client who shares the field, like the opposing metronome in the videos above, begins to operate in sync with the therapist.

Therapeutic change and transformation works through synchronization, and this involves the passage of time. Psychotherapy is a powerful resource that offers deep organic change and psychotherapeutic treatment. Shortcuts and quick fixes has never been the premise of psychotherapy.

On the lighter side…

Want brief therapy? This is what it looks like…

References

Francesetti, G. (2015). From individual symptoms to psychopathological fields. Towards a field perspective on clinical human suffering. British Gestalt Journal24(1), 5-19.

Ludwig von Bertalanffy. (2022, November 20). In Wikipedia. https://en.wikipedia.org/wiki/Ludwig_von_Bertalanffy

Gestalt Therapy Verbatim (Perls, 1969): Book Review

A thousand plastic flowers 
Don’t make a desert bloom 
A thousand empty faces 
Don’t fill an empty room.

Fritz Perls

I enjoy reading this book, written “ad verbatim”, as the title describes. The presentation style gives us an implicit sense of who Perls is and his first-person perspectives as a therapist.

“Gestalt therapy verbatim” is a unique book that gives readers a firsthand look at the ideas and techniques of Gestalt therapy through the words of its founder, Fritz Perls. The verbatim format, in which Perls’ words are recorded exactly as he spoke them during therapy sessions, lectures, and workshops, provides an authentic and engaging look at the development and practice of Gestalt therapy. It can be a valuable resource for those interested in learning about Gestalt therapy or for those who are already familiar with the approach and want to gain a deeper understanding of Perls’ thought and practice.

The book is segmented into two parts – first, an introductory section that describes Gestalt therapy and provides brief background information about its origins and development; and second, three case histories that show how Perls applied his approach during his encounter with the clients named in the case studies.

This is an aged enjoyable book. I have assembled some excerpts here.

Perls on “techniques”

One of the objections I have against anyone calling himself a Gestalt therapist is that he uses technique. A technique is a gimmick. […] We’ve got enough people running around collecting gimmicks, more gimmicks, and abusing them.

Perls adds that Gestalt therapy is not about providing instant cure, instant joy, instant gratification. That works in psychiatry, in addictions, and in today’s world, through the likes of pop-cultured therapy. Gestalt therapy offers all the opportunity for growth, and growth is an organic process. The client has to invest in themselves and grow.

Perls on Anxiety

Anxiety is the gap between the now and the then. If you are in the now, you can’t be anxious, because the excitement flows immediately into ongoing spontaneous activity. If you are in the now, you are creative, you are inventive. If you have your senses ready, if you have your eyes and ears open, like every small child, you find a solution. (p. 23).

He differentiates this from hedonism, where one seek pseudo sensory stimulation. Let us perhaps reflect on how we can relate this concept with the problem of compulsive disorders like sex addiction.

Perls on what happens in the splitting of the self and pathology

You are already coming to the point where you begin to understand what happens in pathology. If some of our thoughts, feelings, are unacceptable to us, we want to disown them. “Me, wanting to kill you?” So we disown the killing thought and say, “That’s not me — that’s a compulsion.” Or we remove the killing, or we repress and become blind to that. There are many of these kinds of ways to remain intact, but always only at the cost of disowning many, many valuable parts of ourselves. The fact that we live only on such a small percentage of our potential is due to the fact that we’re not willing — or society or whatever you want to call it is not willing — to accept myself, yourself, as the organism which you are by birth, constitution, and so on. You do not allow yourself — or you are not allowed to be totally yourself. So your ego boundary shrinks more and more. Your power, your energy, becomes smaller and smaller. Your ability to cope with the world becomes less and less — and more and more rigid, more and more allowed only to cope as your character, as your preconceived pattern, prescribes it. (p.31)

Noteworthy is that this book was written in the 1960s, when the polyvagal theroey concept of introception was not yet discovered. In my practice I do guide the client to separate their ruminating thoughts (that is a bottom-up introception) from conscious thoughts.

Perls’ thoughts on trying to change oneself and others

[W]e realize that we cannot deliberately bring about changes in ourselves or in others. This is a very decisive point: Many people dedicate their lives to actualize a concept of what they should be like, rather than to actualize themselves. This difference between self-actualizing and self-image actualizing is very important. Most people only live for their image. Where some people have a self, most people have a void, because they are so busy projecting themselves as this or that. This is again the curse of the ideal. The curse that you should not be what you are. (p.39)

When we reflect on attitudes on mental health today, which modality is most sought after? The modalities that promote self-image actualization, where there is a delusion that we can change ourselves, our thoughts and our relationships, or the ones that are based on the theory of authentic and organic self actualization?

Perls on Growth, the Impasse, and the aim of therapy

[H]ow do we prevent ourselves from maturing? What prevents us from ripening? […] We ask the question, what prevents — or how do you prevent yourself from growing — from going further ahead? […]

My formulation is that maturing is the transcendence from environmental support to self-support. Look upon the unborn baby. It gets all its support from the mother — oxygen, food, warmth, everything. As soon as the baby is born, it has already to do its own breathing. And then we find often the first symptom of what plays a very decisive part in Gestalt therapy. We find the impasse. Please note the word. The impasse is the crucial point in therapy — the crucial point in growth.

The impasse is called by the Russians “the sick point,” a point which the Russians never managed to lick and which other types of psychotherapy so far have not succeeded in licking. The impasse is the position where environmental support or obsolete inner support is not forthcoming and authentic self-support has not yet been achieved. The baby cannot breathe by itself. It doesn’t get the oxygen supply through the placenta anymore. We can’t say that the baby has a choice, because there is no deliberate attempt of thinking out what to do, but the baby either has to die or learn to breathe. There might be some environmental support forthcoming — being slapped, or oxygen might be supplied.The “blue baby” is the prototype of the impasse which we find in every neurosis. (P. 48)

The process of maturation is the transformation from environmental support to self-support, and the aim of therapy is to make the patient not depend upon others, but to make the patient discover from the very first moment that he can do many things, much more than he thinks he can do.

Perls on Character

The more character a person has, the less potential he has. That sounds paradoxical, but a character is a person that is predictable, that has only a number of fixed responses, or as T. S. Eliot said in The Cocktail Party, “You are nothing but a set of obsolete responses.” (P. 53)

Character is a fixed response that we develop in childhood to manipulate the environment, to get our needs met. The basic need is love from the child’s caregivers, and manipulation comes in the form of playing roles that keep the individual immature.

On changing every question to a statement

“One fool can ask more questions than a thousand wise men can answer.” All the answers are given. Most questions are simply inventions to torture ourselves and other people. The way to develop our own intelligence is by changing every question into a statement. If you change your question into a statement, the background out of which the question arose opens up, and the possibilities are found by the questioner himself.

[…]Every time you refuse to answer a question, you help the other person to develop his own resources. Learning is nothing but discovery that something is possible. To teach means to show a person that something is possible.

Why and because are dirty words in Gestalt therapy.” (p. 64)

when we ask why we get an explanation and we will fail to get an understanding.

Perls on Resentment

We see guilt as projected resentment. Whenever you feel guilty, find out what you resent, and the guilt will vanish and you will try to make the other person feel guilty. […]

If you have any difficulties in communication with somebody, look for your resentments. Resentments are among the worst possible unfinished situations — unfinished gestalts. If you resent, you can neither let go nor have it out. Resentment is an emotion of central importance. The resentment is the most important expression of an impasse — of being stuck. If you feel resentment, be able to express your resentment. A resentment unexpressed often is experienced as, or changes into, feelings of guilt. Whenever you feel guilty, find out what you are resenting and express it and make your demands explicit. This alone will help a lot. (p. 68)

Perls goes on to explain how resentment that is articulated, then switched to appreciation is healing.

Perls on Nothingness and the Fertile Void

The whole philosophy of nothingness is very fascinating. In our culture “nothingness” has a different meaning than it has in the Eastern religions. When we say “nothingness,” there is a void, an emptiness, something deathlike. When the Eastern person says “nothingness,” he calls it “no-thingness” — there are no things there. There is only process, happening. Nothingness doesn’t exist for us, in the strictest sense, because nothingness is based on awareness of nothingness, so there is the awareness of nothingness, so there is something there. And we find when we accept and enter this nothingness, the void, then the desert starts to bloom. The empty void becomes alive, is being filled. The sterile void becomes the fertile void. I am getting more and more right on the point of writing quite a bit about the philosophy of nothing. I feel this way, as if I am nothing, just function. “I’ve got plenty of nothing.” Nothing equals real. (pp. 77-78)

The concept of the Fertile Void is critical to the understanding of Gestalt therapy, a topic which is discussed in these pages:

Perls on taking responsibility and blaming

All the so-called traumata which are supposed to be the root of the neurosis are an invention of the patient to save his self-esteem. None of these traumata has ever been proved to exist. I haven’t seen a single case of infantile trauma that wasn’t a falsification. They are all lies to be hung onto in order to justify one’s unwillingness to grow. To be mature means to take responsibility for your life, to be on your own. Psychoanalysis fosters the infantile state by considering that the past is responsible for the illness. The patient isn’t responsible — no, the trauma is responsible, or the Oedipus complex is responsible, and so on. I suggest that you read a beautiful little pocketbook called I Never Promised You a Rose Garden, by Hannah Green. There you see a typical example, how that girl invented this childhood trauma, to have her raison d’etre, her basis to fight the world, her justification for her craziness, her illness. We have got such an idea about the importance of this invented memory, where the whole illness is supposed to be based on this memory. No wonder that all the wild goose chases of the psychoanalyst to find out why I am now like this can never come to an end, can never prove a real opening up of the person himself. (P. 62)

Considering that trauma work is a critical part of therapy, could Perls’ words in the above passage put into question his credibility on the subject of trauma? Well, before the “Harry & Meghan” saga at the turn of this year, 2023, and before “woke-ism” lost its meaning, which is compassion, I might have considered Perls’ opinion here archaic. However, now I understand what he’s saying. Perls warns us in 1969 that we will want to redeem ourselves from our low self-esteem, and the easy way out of true healing from this shame is to lay blame or make excuses for ourselves. Laying blame is relinquishing responsibility, not what trauma work or psychotherapy is about.

The work with trauma, revealing and processing traumatic events in psychotherapy functions to bring to light childhood pain that the client was not previously able to access. In childhood, the individual adapts to suffering out of context. Adaption to suffering ultimately becomes a fixed pattern of being in the world. This pattern is the personality. When the pain of the past is revealed, it can be felt, sensed and shared. In therapy, the therapist witnesses the suffering that is shared. When this happens, there is enlightenment. The client can then fully grasp feelings they have dissociated from in childhood and infancy. Only then can these feelings be relegated to the past. Feelings relegated to the past will less likely interfere with the present and future without awareness.

The “woke” movement of popular culture today has used the psychotherapeutic process as a Trojan horse for its agenda. Instead of realising suffering and being compassionate to their child-self, the woke seek to redeem themselves of the shame (‘low self-esteem’) from having to suffer childhood helplessness by taking revenge. Revenge is a need for release, to lash out, to whine at the world, to complain and criticise, and it is cathartic. The act of revenge is infantile. The woke person plays the role of victim and perpetrator. In so doing, they fail to mature. They become toddlers in grow-up bodies that can cause destructive revenge. Revenge is violent, and the acts do not heal anyone. Revenge is the transfer of pain from the sufferer to their victims through violence. Violence is the transference of pain that is absent in the perpetrator to the victim. Pain is transferred until it is transformed (Weil, 1952, in this article).

Perls on Group therapy

Basically I am doing a kind of individual therapy in a group setting, but it’s not limited to this; very often a group happening happens to happen. Usually I only interfere if the group happening comes merely to mind-fucking. Most group therapy is nothing but mind-fucking. Ping-pong games, “who’s right?,” opinion exchanges, interpretations, all that crap. If people do this, I interfere. If they are giving their experience, if they are honest in their expression — wonderful. Often the group is very supportive, but if they are merely “helpful,” I cut them out. Helpers are con men, interfering. People have to grow by frustration — by skillful frustration. Otherwise, they have no incentive to develop their own means and ways of coping with the world. But sometimes very beautiful things do happen, and basically there are not too many conflicts, everybody who is in the group participates. Sometimes I have people who don’t say a single word through the whole five-week workshop and they go away and say that they have changed tremendously, that they did their own private therapy work or whatever you want to call it. So anything can happen. As long as you don’t structure it, as long as you work with your intuition, your eyes and ears, then something is bound to happen. (p. 93)

Reference

Perls, Frederick (Fritz). (1969/1992) Gestalt Therapy Verbatim (p. 93). The Gestalt Journal Press. Kindle Edition.

Fritz Perls: What is Gestalt? 1970 Video

The founder of Gestalt therapy, Fritz Perls tells us in his own voice in this gem of a video. What gestalt therapy is. Listen to this, and we can make up our minds as to how relevant this modality of psychotherapy Gestalt therapy is, and has developed till today.

This is what Fritz tells us…

The idea of Gestalt therapy is to change paper people to real people. To make the hollow men of our time come to life and teach him to use his inborn potential. To be a leader without rebelliousness. Having a center without being lopsided.

The social milieu in which we find ourselves, regulated by “should-isms”, by Puritanism where you do your thing whether you like it or not; or by the other extreme, hedonism, “where we live for fun and enjoyment, being turned on anything goes as long as it is nice.”. We become phobic towards pain and suffering.

We avoid and run away from frustration or pain. The result is the lack of growth. [He is not talking about masochism].

The main idea about Gestalt is that Gestalt is about the whole; about being complete. This involves guiding the person to feel, sense and perceive the present (the now), even painful emotions, and allowing the self understand the now and be integrated in the experience.

We ask how. We don’t ask why. Asking ‘how’ helps us to understand. It is in understanding that we can change structure of our life script.

Therapeutic Autoethnography

Doctorate Dissertation 2023

Abstract

Therapeutic Autoethnography is founded on Autoethnography, an emergent field in qualitative research. Therapeutic Autoethnography engages the practitioner as a researcher in the field of the psychotherapy situation. It is a practice-based, practice-driven, practice-informed qualitative research method. It provides an in-depth understanding of what goes on in the diverse naturalistic setting of psychotherapy practice. In Therapeutic Autoethnography, the field being investigated is the therapy situation, which encompasses the individuals attending the session, the therapeutic alliance, and its environment. In the role of researcher, the therapist creates aesthetic accounts of their experiences in the field with their client(s). The writing process is deliberately reflexive and integral to the method. This act of creative writing is a heuristic process where new insights emerge for the researcher. This thesis demonstrates how Autoethnography can be applied as a practical methodology for psychotherapy case study research, especially for explicating the implicit nuances in therapy. 

Keywords: Autoethnography, Therapeutic Autoethnography, psychotherapy research, case study research

academia-Chew-Helbig-Therapeutic-A

Reference

Coming soon

Geštalt Zbornik 9: Understanding Salomo Friedlaender’s Creative Indifference

Understanding Salomo Friedlaender’s Creative Indifference: A Psychotherapy Case-Study.

Abstract

Salomo Friedlaender’s Creative Indifference, or Schöpferische Indifferenz, first published in 1918, is a founding philosophy of Gestalt therapy that has invaluable implications in the process of psychopathology in the psychotherapeutic process. This article features a psychotherapy case study of a client who has been diagnosed with Major Depression and Atypical Anorexia Nervosa. The case story is written by the therapist using Therapeutic Autoethnography, a method of inquiry into the psychotherapeutic process. Writing this case study in an evocative aesthetic form, the understanding of Creative Indifference is fleshed out and enriched. Story and theory are interwoven reflexively to illuminate how aspects and meanings of Friedlaender’s philosophy of Creative Indifference, the centering in the here-and-now, the fertile void and zero point, apply to the real-life, naturalistic situation of psychotherapy practice. Though the case study details but a portion of the client’s work, one can grasp the atmosphere from which the client’s pathos is made visible. Creative Indifference facilitates this process of psychopathology in a powerful way, expanding our understanding of suffering beyond the traditional attitude of clinical diagnosis.

Keywords: autoethnography, psychotherapy case studies, psychotherapy process research, gestalt therapy, aesthetic inquiry

Excerpt from the Case Study: “Stuck”

The leather armchair seems massive as she slumps into it. Min looks almost childlike, dangling her chunky Dr. Martens covered feet. “I just feel hopeless and devastated,” she says. “It’s my birthday today, and I thought I bought myself a gift.” That “gift” , she explains is the “gift of therapy”. I would have mistaken her for another cosplay preteen, wearing a head of neon green dreadlocks, had she not revealed that today she turns 29.

“What do you do here in Vienna?”

“I work at a Konditorei.”

“Are you studying here as well?”

“Not any more. I actually moved to Vienna for study at a university. The exams were too hard and I got stuck.” Min explains that she’s been living in Vienna for three years, shares an apartment with 3 Russian-speaking housemates and has few friends here.

This is our first moments together and I find myself mesmerized by the girl looking back at me. The small body, the square shaped face, the big head that tilts to the left as she smiles reminds me of someone familiar. Very familiar.

I ask her if there is anything that she needs to know about therapy at this point.

“Uh. This is my very first time doing therapy, and I don’t know what I want.”

“How did you choose to contact me?”

“Oh… I saw in your profile that you are social, with group therapy and all… and that you were doing something cultural.”

[…]

“I had to think for myself,” she says, “but now, as an adult, I feel dependent.”


Chew-Helbig-2022-creative-Indifference

Reference

Chew-Helbig, N. (2022). Understanding Salomo Friedlaender’s Creative Indifference: A Psychotherapy Case-Study. Geštalt Zbornik. 9, pp. 5-15 https://www.ceeol.com/content-files/document-1127011.pdf

Find this Journal here: https://www.ceeol.com/content-files/document-1127011.pdf or request a copy from me.

EUJPC 1 (16): A psychotherapist’s lived experience in-session with an asylum seeker and translator

A psychotherapist’s lived experience in-session with an asylum seeker and translator: An autoethnographic case study

Abstract

Featured in this article is a psychotherapy case study recounted from the lived experience of the psychotherapist working with an asylum seeker from Afghanistan, with the help of a translator. The method applied is an aesthetic inquiry adapted from Autoethnography which engages the practitioner as the researcher who enters the ‘field’ of the therapy situation. The reflexive writing of the case story, which is integral to the method, sets off a heuristic process, integrating research and practice. Reading this case study, one may grasp the nuances and the atmosphere of an otherwise linguistically challenging therapeutic situation. The story and Gestalt therapy theory are weaved together, which makes palpable, intangible aspects of the therapeutic process.

Keywords: autoethnography, psychotherapy case studies, psychotherapy process research, gestalt therapy, aesthetic inquiry

An excerpt from the Story in the Article

I want to be confident, but something in my past is stopping me,” Zaya translates.

I give Ali a nod to acknowledge what I am hearing. He smiles back at me. His jacket hangs on a clothes rack by the door. This is the start of our second session.

Ali’s opening sentence this morning feels like an invitation. Ali stands by a threshold between the future and the past. He points us in the direction of the past. I see him shudder. I shudder, though I do not know what it is I am seeing. I am interested, in earnest. I am also wary. I lean back.

***

I ask Ali what he meant by the past stopping him from being confident.

“Uncle.” Ali explains that uncle is the younger brother of his father. Ali was put in the care of uncle and his wife when he was 9 years old. Till he turned 18, Ali lived with the couple and their daughter, who’s a little younger than Ali. “I always hear uncle say, ‘you will come to nothing. Nothing’.”

“What would you say to him right now, if he is sitting here?” I ask.

Zaya translates.

Ali clenches a fist, then promptly holds it down with the other hand. “I have no words, nothing.”

“Yes.” I say. I give space to the young man’s rage. Zaya reaches gingerly for a filled paper cup and takes a sip. Ali and I follow suit.

I ask him how he got to be put in the care of uncle.

 “After school I play football. The playground is near my house. One day, I was playing football, then the bomb of the Taliban exploded on our house.” Zaya translates this, ice cold. They were all home when it happened; Ali’s father Zabi, his mother, Fatemeh and his baby sister Khatere. Ali’s voice cracks as he mentions the name of his baby sister. He stares, glassy-eyed, blank.

The skin on the back of my neck tingles. I glance towards the radiator by the window, as if to check if it was turned on properly. No, the air in the room is not cold. I am being touched by phantoms who have now descended amongst us. I search my bag for paper, only to find a dog-eared stack of neon coloured post-its. I write, “Zabi”, “Fatemeh”, “Khatere”, on three little sheets, careful to get the spelling right. I lay the post-its on the coffee table. I feel tears well up in my eyes. The space between us is saturated.

***

“How… are… you?” Ali asks me in English, then giggles.

“Thank you, Ali,” I say. “I slept well, so this morning you have my fullest attention.”

 Zaya translates.

“How about you, Zaya,” I ask.

I catch a slight blush in her cheeks, as she giggles, “very well.”

“Ali says that he doesn’t sleep well. For example last night he had a bad dream. A nightmare.” Zaya translates.

“There is the mafia,” Ali says, “who is raiding the castle. Me and my friends are hiding in it. The mafia shoots me. I’m almost dying and my friends save me. My father is there. Oh. But that is only for a short time. I fall out of the window and run away.”

 We share a round of chuckling. I offer Ali and Zaya a suggestion to do a chair work. Zaya’s eyes lights up. I’m aware that she had read much about the Gestalt therapy method of working with dreams. “I’m not sure if you’d like to try this exercise.” I say to Ali, who is probably sensing Zaya’s interest.

“Yes. Yes,” is his reply.  

“Well, if at any time either of you are feeling unwell doing this dreamwork, say stop.” I tell them.

 “Yes. Yes,” he says.

Zaya translates, “What do I do?”

So we set the stage with empty chairs around us. I am thankful for having booked this larger room again this morning. Ali puts a chair for “the mafia” a distant right from his. He then says that the rows of chairs stacked up along the wall of the room are where his friends sit. He takes the last chair and places it close behind him slightly to his left; there Ali seats his father.

***

Conference Presentation

Reference

Chew-Helbig, N. (2022). A psychotherapist’s lived experience in-session with an asylum seeker and translator: An autoethnographic case study. European Journal of Psychotherapy & Counselling, 1-16.

Find this Journal here: https://www.tandfonline.com/doi/abs/10.1080/13642537.2022.2156138

or request a copy from me.

The British Gestalt Journal 31(1): Writing evocative case studies

Writing evocative case studies: applying autoethnography as a research methodology for the psychotherapist.

Abstract

This is an introduction to the application of autoethnography, a qualitative research method, an aesthetic inquiry into the psychotherapy process. The method engages the practitioner as researcher-autoethnographer who enters a field, which is their client’s therapy process. The aim is to derive insights and deepen the understanding of process, theory and diagnostics from psychotherapy sessions in practice. The therapist creates a reflexive account of their experiences, recording this in their session notes, which are also the field notes and the data. As an autoethnographer, the therapist begins therefrom a process of creative writing. The writing process is reflexive, and aesthetic. Integral to the research method, the act of writing forms a hermeneutic circle where new insights into the phenomenon of therapy happen for the researcher. The writing is created as an art form, usually a story or poetry. The result of this method is a written, evocative, aesthetic representation of the therapy process, based on the phenomenological experience of the practitioner. Demonstrating this method, a single case study of an online Gestalt therapy session of a male client diagnosed with depression and borderline personality disorder is featured in this article. The outcome of this form of aesthetic inquiry is the embodiment of psychotherapy theory through the aesthetic sensibility of the therapist-researcher.

Keywords: autoethnography, psychotherapy case studies, psychotherapy process research, gestalt therapy, aesthetic inquiry

Excerpt

In Gestalt therapy practice, aesthetic sensibility to the atmosphere is instrumental to the therapist, in order that they can attune to the movement of the phenomenological field (Francesetti, 2015). This is where this research methodology aligns with Gestalt therapy practice. Theory of the phenomenological field is central to Gestalt therapy (Parlett, 1991; Staemmler, 2006; Francesetti, 2019; Philippson, 2009; Robine, 2006; Spagnuolo Lobb, 2013) as it is in psychology (Lewin, 1951). Attunement to the aesthetics of the phenomenological field allows therapists to move beyond the mono-personal, third-person attitude of diagnosing the client’s psychopathology using manuals like the DSM (American Psychiatric Association, 2013) and evaluating clients using psychometrics. It goes even beyond the bi-personal, relational attitude of inquiry into the therapeutic alliance (Greenberg, 1986; Clarkson, 2003; Jacobs & Hycner, 2009; BCPSG, 2010). Aesthetic attunement brings the psychotherapeutic process beyond therapist and client, into the atmospheric realm of the phenomenological field of the here-and-now.

Reference

Chew-Helbig, N. (2022a). Writing evocative case studies: applying autoethnography as a research methodology for the psychotherapist. The British Gestalt Journal, 31(1), 35-42.

Find this Journal here: https://www.britishgestaltjournal.com/shop/british-gestalt-journal-311 or request a copy from me.

The change moments in psychotherapeutic practice 

The challenge with humanistic psychotherapy today is to realize the philosophical con­cepts and theory put into practice. How do we see an I-thou moment in a therapy ses­sion? 

My personal conviction in this topic is borne by the fact that I have experienced change moments – as a client of psychotherapy. Over the years, I have also been able to tell if these change moments had a lasting effect, or if they were just cathartic or tempo­rary because of suggestion and coercion. Perception of from the client’s point of view recorded over lifetime (a couple of years), may be essential aspect of psychotherapeutic process research. 

The process of defining the healing I-Thou moments (Buber, 1936) in psychotherapy often gets lost in language. What some call the transcendental phenomenon (which I have in this paper related to an aspect of Clarkson’s framework), is also called “miracle moments” (Santos, 2003), “sacred moments” (Pargament, 2007), and “moments of meeting” (The Boston Change Process Study Group, 2010). 

What is typically experienced in this moment is typically described like this: “Every therapist knows that there are some special moments in psychotherapy. I experi­ence them as “sacred moments” when immediate realities fade into the background, when time seems to stand still, when it feels as if something larger than life is happen­ing. In these moments, I believe, a meeting of souls is taking place. This was one of those times” (p. 6). 

I had the benefit of attending a presentation at a Gestalt Associates Los Angeles (GATLA) Summer Residential in Lisbon this year which discussed this very topic of defining these moments of encounter. Entitled, I-thou moments in psychotherapy, the study is the result of meta-analyses of psychotherapeutic literature and interviews with therapists. Hence it was found that these I-thou moments: 

  • are memorable, exists in psychotherapy and appears every now and then.
  • are recognizable, significant events.
  • is based on the quality of dialogue.
  • short lasting (in seconds).
  • is rare.
  • is mutually experienced.
    During these moments 
  • perception gets narrowed.
  • there is an unusual level of understanding and acceptance of the other
  • there is experience of being on the edge of something spiritual.

These moments lead to long term change in the therapy and result in motivation for the client to further therapy work. It strengthens the alliance, and has no negative affects (unlike transference relationship). It is also a qualitatively viewed process, and is often arises from sharing of heavy topics and staying long enough at an oftentimes uncomfortable place. Playing the role “I am the therapist, you are the client” prevents these moments from happening. The challenge in studying these moments is the very fact that in trying to grasp the moment, that moment is lost (Pernicka, 2016).

References

Buber, M. (1936). Ich und Du. Berlin: Schocken.

Pargament, K. (2007). Spiritually integrated psychotherapy: Understanding and addressing the sacred. NY: Guilford Press.

Pernicka, M. (2016, July). I-Thou moments in Psychotherapy. Lisbon, Portugal.

Santos, A. M. (2003). Miracle Moments: The Nature of the Mind’s Power in Relationships and Psychotherapy. iUniverse.

The Boston Change Process Study Group. (2010). Change in psychotherapy. NY: W. W. Norton & Co. .

Empathy and Buber’s I-thou contact

I do not fully agree with Schmid’s implication that empathy is about “try(ing) to understand, as exactly as possible, the accurate meaning of what goes on inside another person in the very moment”. This is the common understanding of empathy, but it actually contradicts the principle of Buber’s (1970) I-Thou contact. “Trying to un­derstand” is a process of someone doing something with an aim to furnish a need in oneself. In this case, it is the need to understand “as exactly as possible”. If a therapist has this kind of goal, his/her goal may become a blockage to contact because he/she is distracted by the need to interpret and the need to establish his/her identification as therapist in the relationship. 

Wouldn’t this amount to using the client to find-out-something-so-that-I-can-do­my-therapist-job? This kind of objectifying the Other in the relationship leaves room for transference and countertransference neurosis. If empathy is as what is generally under­stood as described above, it is then not part of the I-Thou relationship, because the I­Thou relationship excludes objectification. 

The I-Thou contact requires seeing the Other first, and not seeing the other in re­lation to oneself. This movement towards the other first is what Emmanuel Levinas considers the ethical movement (Schmid, 2001). 

Schmid clarifies this disparity later in the article in stating the difference between Roger’s and Buber’s comprehension of the activity of making empathic contact. Be­sides what is mentioned, Rogers also believes that it is necessary “to put one’s own un-derstanding completely apart” if one wants to enter the world of another person empath­ically. Buber, on the other hand believes in the mutuality of the process. 

That which lies beneath the I-thou contact is not empathy but something more than empathy. Buber (1970) uses the word, Umfassung, a phenomenon of embracing, which is “more than empathy”. This process requires the recognition of 2 poles, in en­countering the other “as a partner in a bipolar situation” (p. 178). This implies a dynam­ic relationship of “swinging into” (einschwingen) into the experience of the other and at the same time maintain one’s own reality of the self. It shows a dynamic process of be­ing existentially affected by the other, and including the other person into one’s own existence (Schmid, 2001). 

This is not the same as to “trying to understand someone as exactly as possible”, or to step into someone’s shoes. It is rather about me being me, seeing you, and show­ing you how you affect me— at this present moment. 

This way of relating in the present moment is what Buber calls, personale Vergegenwärtigung. It is an elementary way of relating and means to expose oneself to the presence of the other. This is a personal way of becoming aware of, a way of ac­ceptance instead of perception, a way of acknowledgment instead of knowledge (Schmid, 2001). 

The I-Thou relationship is basic existential relationship without the complications of identity and needs. The healing power of this relationship is in the confirming of the other for who he/she is. Buber is quoted to use the word Realphantasie, which indicates that what is happening is that “the Other’s reality is touched” (ibid.). What is experi­enced through this form of relationship is the transpersonal, intersubjective acknowl­edgment of the other, affirming the identity of the other through the presence of the self. Both partners in the relationship attains affirmation of the self. This benefit is mutual, and the relationship is symmetric. What happens in this mutual exchange, Staemmler (2009, p. 96) explains is not a “fusion of horizons”—which happens with just empathy alone— but a widening of each other’s horizons in such a way that that it is integrated with each other’s personal background.

References

Buber, M. (1936). Ich und Du. Berlin: Schocken. 

Buber, M. (1970). I and Thou (Kindle ed.). (W. Kaufman, Trans.) Charles Scribner’s Sons.

Gadamer, H. G. (1975/1960). Truth and method . (G. Barden, & J. Cumming, Trans.) NY: Seabury. 

Schmid, P. F. (2001). Comprehension: the art of not-knowing. Dialogical and ethical perspectives on empathy as dialogue in personal and person-centred relationships. Empathy, 53-71.

Staemmler, F.-M. (2009). The willingness to be uncertain: Preliminary thoughts about intepretation and understanding in Gestalt Therapy. In L. J. Hycner (Ed.), Relational approaches in Gestalt Therapy (pp. 65-110). NY: Gestalt Press.