Category: Gestalt Therapy

Gestalt Therapy articles

Treatment of Compulsive Sexual Behaviour Disorder (CSBD): A Gestalt Therapy approach

Introduction

Out-of-control sexual behaviour was documented as early as the 3rd century by St Augustine and later from the mid-18th century by medical pioneers such as Benjamin Rush (1745–1813) and sexologist Richard von Krafft-Ebing (1840–1902). Krafft-Ebing observed one patient suffering:

To such an extent that permeates all his thoughts and feelings, allowing no other aims in life, tumultuously, and in a rut-like fashion demanding gratification and resolving itself into an impulsive, insatiable succession of sexual enjoyments. This pathological sexuality is a dreadful scourge for its victim, for he is in constant danger of violating the laws of the state and of morality, of losing his honor, his freedom, and even his life. (Krafft-Ebing, 1886) (in McKinney, 2014)

Definition of Compulsive Sexual Behaviour Disorder (ICD-11)

Compulsive sexual behaviour disorder (CSBD) is characterised in the ICD-11 (International Classification of Diseases, 11th Revision, World Health Organization, 2018) as,

“a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour. Symptoms may include repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behaviour; and continued repetitive sexual behaviour despite adverse consequences or deriving little or no satisfaction from it. The pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behaviour is manifested over an extended period of time (e.g., 6 months or more), and causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to meet this requirement.”

The classification of Compulsive sexual behaviour disorder as an impulse control disorder is being debated. Some in the DSM camp, that has not classified this disorder, argue that hypersexuality is more related to addiction than compulsion. We can consider both arguments to be true.

Diagnostic requirements (ICD 11) are as follows:

  • A persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour, manifested in one or more of the following:
    • Engaging in repetitive sexual behaviour has become a central focus of the individual’s life to the point of neglecting health and personal care or other interests, activities and responsibilities.
    • The individual has made numerous unsuccessful efforts to control or significantly reduce repetitive sexual behaviour.
    • The individual continues to engage in repetitive sexual behaviour despite adverse consequences (e.g., marital conflict due to sexual behaviour, financial or legal consequences, negative impact on health).
    • The person continues to engage in repetitive sexual behaviour even when the individual derives little or no satisfaction from it.
  • The pattern of failure to control intense, repetitive sexual impulses or urges and resulting repetitive sexual behaviour is manifested over an extended period of time (e.g., 6 months or more).

The patient is not considered to be diagnosed with CSBD if:

  • There is another mental disorder that can better explain the behaviour, e.g. mania, or if the patient’s behaviour is due to drug use or medications.
  • The personal and relational distress experienced is due to moral judgement and societal disapprovements.

Variations of Compulsive Sexual Behaviours and Sex Addiction

There are controversies surrounding labelling behaviours as CSBD and debate over whether the behaviour should be considered a disorder or a moral judgment. Sexual habits become disordered when the relationship to the behaviour becomes a problem to the individual’s life. Compulsive sexual behaviours include dysfunctional pornography use, excessive use of sexual services, chem sex, and sexual acts done indiscriminately with consenting or non-consenting others.

Life Consequences caused by CSBD

Patients who arrive to therapy seeking help to overcome CSBD reveal how seriously their compulsive sexual habits affect their personal lives. They seek therapeutic intervention on their own accord or through the advice or demands from loved ones.

  • Loss of jobs due to porn use at work
  • Legal issues
  • Damaged intimate relationships
  • Negatively affected social standing
  • Diminished libido
  • Sexually transmitted diseases
  • Sexual dysfunction
  • Escort /sex-worker engagement
  • Substance abuse
  • Physiological issues, e.g. insomnia
  • Social isolation, anxiety, depression, self-harming behaviours.

Who are at risk of developing CSBD?

Many individuals with CSBD report having experiences of acting out during pre-adolescence or adolescence, engaging in risky sexual behaviour, masturbation and using explicit material to cope with emotional challenges.

Other factors that have been found to increase the risk of developing CSBD are:

  • Early exposure to sexually explicit material.
  • Early onset of internet use.
  • Childhood sexual abuse.

There are gender differences associated with CSBD:

  • Most clients who report having CSBD are men of all sexual orientations.
  • Women with CSBD usually label themselves as “love addicts”. They are more likely to report having experienced sexual abuse at an early age.

How Addiction to the Compulsive Sexual Behaviour Starts

Hall (2018) categorized broadly the processes in which sexual addictive behaviours are induced in individuals. We can consider that the individual may be influenced through one or more induction processes.

  • Opportunity-induced: with internet pornography accessible with just a mouse click, it becomes the cheapest, lowest-hanging self-soothing treatment choice. Several clients who are addicted to hiring escorts or sex workers report having lived in proximity to brothels and within sex districts as children.
  • The Trauma-induced: children and pre-adolescents discover masturbation as a means of self-soothing and coping with anxiety-triggering home environments.
  • The Attachment-induced: the child learns to cope with loneliness due to percieved neglect or abandonment by primary care-givers by self-gratifying and living in their sexual fantasies. These children are also more likely targets of grooming by sexually-predatory adults.

The psychotherapeutic approach to CSBD treatment needs to be holistic since the source of addictive sexual behaviour is multi-factorial.

How Addictive Behaviour is Reinforced

Psychotherapy with clients dealing with addictions is primarily about getting roadblocks out of the way. These roadblocks impede the client’s ability to break the cycles of addiction. If the client cannot break the cycle, the addiction is reinforced.

Addictive behaviours oscillate between the individual’s need for control or release, in a flip-flop between extreme states of euphoria and despair, avoidance and surrender, self-punishing (guilt) and exhaustion (shame).

Hall (2018) also introduced the six-phase cycle.

The Compulsive Sexual Behaviour Disorder cycle is repetitive, rendering the patient helpless to stop the habit.

This is the compulsion cycle.

There lies in going through this cycle repeatedly, painful feelings of deep-seated guilt and shame. The individual with CSBD is particularly likely to suffer this intensely and alone, keeping the habit out of the scrutiny of others for fear of persecution or being made to halt the habit.

The way out of this psychological pain is for the psyche to form cognitive distortions, like rationalizing, justifying, minimizing the impact, magnifying the need, blaming others and situations for causing them to be addicted, and feeling entitled/deserving of the pleasure, denying the gravity of the behaviour and its potential dangers.

Comorbidity with other Psychiatric Disorders

A recent study in Spain showed that over 90% of CSBD participants met the criteria for at least one Axis I disorder, compared to 66% of non-CSBD participants. CSBD participants were more likely to report an increased prevalence of alcohol dependence (16.2%), alcohol abuse (44%), major depressive disorder (39.7%), bulimia nervosa (5.9%), adjustment disorders (20.6%), and other substances –mainly cannabis and cocaine– abuse or dependence (22.1%). The prevalence of borderline personality disorder was significantly higher in CSBD participants (5.9%). (Ballester-Arnal et al., 2020).

Neural Correlates of Compulsive Sexual Behaviours

Voon et al. (2014) provide a study of the neurobiology of CSBD in this article.

Through fMRI brain imaging comparison studies of CSBD and healthy subjects, they were able to draw the following confirmation and conclusions:

  • That the neural circuits that govern the reward processing in compulsive sexual behaviour and substance dependency overlap.
  • That the CSBD group, compared to healthy individuals, had higher “desire” but similar “liking” scores when exposed to explicit sexual material.
  • Exposure to sexually explicit cues in CSB compared to non-CSB subjects was associated with activation of the dorsal anterior cingulate, ventral striatum and amygdala.
  • Functional connectivity of the dorsal anterior cingulate-ventral striatum-amygdala network was associated with subjective sexual desire (but not liking) to a greater degree in CSB than non-CSB subjects.

In CSBD subjects, there is evidence of a dissociation between desire (or wanting) and liking towards sexually explicit material. This split is a consistent phenomenon associated with drug addictions.

“Sex and porn addiction are not driven by the physical essence of libido but by the psychological need to satisfy a deeper subconscious urge, or to satisfy the biological craving in the brain” and is not correlated with high sex drive (Hall, 2018, p. 7). The motivation for such behaviour is to dissociate oneself from reality and the painful feelings that are present in it.

This demonstrates the splitting that exists in subjects with CSBD.

Gestalt Therapy for Treatment of Compulsive Sexual Behaviour Disorder

Considering the conditions and phenomena around CSBD, Gestalt therapy is arguably a model psychotherapeutic method for treating CSBD. Gestalt therapy, more evident than other modalities, directly addresses intra-psychic splitting mentioned in the above section. Therapeutic work revolves around integration. Integrative Gestalt therapists adopt a holistic approach when working with clients.

Gestalt Awareness Continuum approach and Contact Interruption in CSBD

Dissociation points us to realise the impact of trauma, particularly childhood trauma, on clients.

In Gestalt Therapy, we stay in contact with the client by being attentive to the interruptions in the contact cycle. This therapeutic philosophy is more effective than trying to get the client out of or breaking the compulsion cycle. This is the way to therapeutic change, even though the client who is desperate to break the cycle may not appreciate this.

The Therapeutic Contact begins before the Beginning.

This is also known as the pre-contact phase.

Clients approaching us for therapy may or may not pose CSBD as a presenting issue. There are possible reasons for this:

  • There are more pressing issues that are at the forefront of their minds,
  • The client is in denial that the habit causes dysfunction,
  • The shame of revealing the habit.
  • Fear of persecution.

As therapists, we can be alert to the possibility of CSBD being presented to us later in therapy, which happens when the client feels secure enough in the therapeutic alliance.

The first meeting is very important even though its significance is often overlooked or overshadowed by intake matters. This is the point when the therapist encounters the field of the client. It is like the moment we touch a bucket of cold water. The moment before our organism adjusts to the differences. In this pre-contact phase, we sense the client’s existence most acutely as foreign to ours. The fertile void lies amidst this differentiation.

The Paradoxical Theory of Change in the Treatment of CSBD

We acknowledge the sense of urgency when clients approach psychotherapy to “fix” their addictions. The therapist often feels drawn to this strife. Our first instinct is to yearn for a solution, knowing that diving to “solve the problem” is not the solution. Beisser’s (1970) Paradoxical Theory of Change, a cornerstone of Gestalt therapy theory, becomes an invaluable resource. Biesser adds, “(b)y rejecting the role of change agent, we make meaningful and orderly change possible.”

This does not mean therapists do not care if the client overcomes the addiction. We do, as that is the working contract. It means that therapists do not position themselves as the “maker of change”.

The client overcomes an addiction, and in this case CSBD, in a therapeutic change process of self-actualization. Self-actualization is the holistic embodied shift a person experiences almost unconsciously, sometimes spontaneously. This phenomenon happens with clients in therapy for a period of time. Perls explains that we cannot make ourselves self-actualize as it is not an active process:

[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. (Perls, 1969 p.39)

As Gestalt therapists, we are aware of this change process. Our work is to support change through working with the client. The client self-actualizes within the field of the therapeutic relationship. Changes in the field actualize the field, bringing about change to the individuals within it.

Psychopathology is a Phenomenological Process in Gestalt Therapy

Psychopathology is a process. It is not the same as using a diagnostic manual and questionnaires to diagnose a patient and then telling the patient what ailment they suffer from.

Psychopathology is process.

Psychopathology relies upon the following:

  1. Observing while avoiding theoretical explanations, presuppositions and prejudices, confining ourselves to the presenting phenomenon in the therapeutic encounter, and
  2. The attempt to use empathy as a clinical instrument ‘to recreate in the psychopathologist the subjective experience of a patient to obtain a valid and reliable description of his experience.’ (Stanghellini & Fuchs, 2013, p. xviii)


Psychopathology is conceptualised as a process in psychotherapy of bringing to light and making palpable the essence of the suffering of the client. It is through this “en-lightening” or illumination process that therapeutic change can be effected. This process is integral to therapy. It is the therapeutic contract, exists in the therapeutic alliance, and is responsible for therapeutic change.

Gestalt therapy engagement in the phenomenological field persuades the therapist to focus on the process of psychopathology and to perceive the atmosphere of the co-created field of the therapy situation. Through this process, we uncover pathos and painful emotions from trauma while being present with the clients in the here and now. In working with clients with CSBD, this process is crucial for understanding/validating the underlying triggers and suffering the client avoids through addiction.

Shame, Guilt, Despair and Helplessness in the Co-created field

CSBD suffer the pain of shame due to their condition more than any other addicts. Working through shame is fundamental to therapeutic work and is even more crucial when clients struggle with CSBD.

Working with shame in therapy, there needs (Yontef, 1996),

  • Empathic understanding of the patient’s experience with shame
  • Assist the client in understanding this experience fully.
  • Showing warm understanding, acceptance and respect.
  • To heal shame, the therapist must understand shame. The therapist must understand this in the context of the patient.
  • The therapist must be committed to dialogue (Buber, 1970/1936).
  • Hold the client in unconditional positive regard.

Shame is an emotion that holds together the therapeutic alliance when brought into the open. It becomes part of the co-created field. Despair, on the other hand, threatens to break the alliance. This is especially so in work with addictions. Despair is the feeling of resignation and disappointment, especially when relapses happen. Resignation is the sense that there is no hope of resolving the problem, followed by disappointment in the therapy. Recognizing the possibility of despair early in the therapeutic process is helpful.

Creative Indifference as Central Attitude when working with CSBD

Salomo Friedlaender’s “Creative Indifference,” also known as “Schöpferische Indifferenz,” was published in 1918 and is considered a seminal philosophy of Gestalt therapy. Creative Indifference incorporates philosophical values that serve as the bedrock for humanistic psychotherapy approaches like Gestalt therapy:

  • “Creative” = to make something exist out of a void.
  • “Indifference” = to be unbiased, to be present without agenda.
  • Holism = to perceive wholes as more than the sum of parts.
  • Inter-subjectivity = the co-creation of the field.
  • Intentionality (including creative will and decision-making), and
  • Nondualism (emphasising exemption from isolation).
  • The Creative pathos.
  • Creative relatedness.
  • Authentic self.

Read more: Understanding Salomo Friedlaender’s Creative Indifference and The Fertile Void

Polarities as depicted in Zinker (1977).

These values ground the therapist working with CSBD clients. The nature of the pathos in CSBD is compulsivity, guilt and shame, alternating with bouts of despair and helplessness. These feelings exist within the co-created therapeutic field. The therapist will experience these feelings. It is the work of the therapist to willfully attune to the phenomenon of the field and to grasp the feelings that exist in the atmosphere of the therapeutic situation. Creative indifference acknowledges a fertile middle point between polarities (and differences) where contact exists.

Conclusion

CSBD is a complex psychological and physiological challenge to work with clients through in psychotherapy. Shame is an individual’s predominant experience with the disorder, leading many clients to avoid the subject at the beginning of therapy. A contactful therapeutic alliance built on solid footing initiates the treatment process.

The therapeutic change process is organic and progressive. Focussing the work on the abstinence of behaviour alone does not promise a positive outcome of treatment. Therapeutic change depends on the ability of both client and therapist to stay with the process and have the patience and faith to see through cyclical moments of complicated feelings of shame, guilt, and despair. This involves trauma work as well. Feelings of despair usually cause either party in the alliance to give up on the work. The client may despair upon relapse, and the therapist may feel helpless when confluent with the client.

CSBD is a diagnosis categorized only recently in the ICD-11. Having CSBD defined in diagnostics is crucial to recognising and treating the disorder. Clinical diagnosis alone, however, is useless to the therapist. The therapeutic process involves the unearthing of the pathos /or suffering/ trauma that underlie the symptoms. This is the process of psychopathology, which requires sensitivity to uncover and make graspable these feelings, or pathos. Following which, something shifts in the system.

Gestalt therapy engages the phenomenon of the co-created field. This is an ideal philosophy for treatment as it is in the field that the psychopathology in the field comes to the foreground and is witnessed. This works best in the treatment of CSBD, since the behaviour is a dissociative, self-soothing mechanism, which can be “unlocked” only when the client is able to grasp the mental suffering from which they are soothing themselves with the behaviour.

Case Study of “John”

Case study of “Businessman John” 40, was presented in the talk on 4 Mar 23 to DRM (Derimu) Psychological Education, 德瑞姆无形完形俱乐部, China (https://www.deruimu.com/).

References

Ballester-Arnal, R., Castro-Calvo, J., Giménez-García, C., Gil-Juliá, B., & Gil-Llario, M. D. (2020). Psychiatric comorbidity in compulsive sexual behavior disorder (CSBD). Addictive behaviors, 107, 106384

Beisser, A. (1970). The paradoxical theory of change. Gestalt therapy now, 1(1), 77-80.

Buber, M. (1936/70). I and Thou. Kindle ed. (W. Kaufman, Trans.) Charles Scribner’s Sons.

Frambach, L. (2015). Philosophie, Mystik, Psychotherapie. Die Bedeutung Salomo
Friedlaenders für die Gestalttherapie. In D. T. L. Frambach (Ed.), Friedlaender /
Mynona und die Gestalttherapie. Das Prinzip “Schöpferische Indifferenz. EHP.

Hall, P. (2018). Understanding and Treating Sex and Pornography Addiction: a comprehensive guide for people who struggle with sex addiction and those who want to help them. Routledge.

Lee, R. G., & Wheeler, G. (2013). The voice of shame: Silence and connection in psychotherapy. Gestalt Press.

McKinney, F. (2014). A relational model of therapists’ experience of affect regulation in psychological therapy with female sex addiction (Doctoral dissertation, Middlesex University/Metanoia Institute).

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

Stanghellini, G., & Fuchs, T. (2013). One century of Karl Jaspers’ general psychopathology. (G. Stanghellini, & T. T. Fuchs, Eds.) Oxford University Press.

Voon, V., Mole, T. B., Banca, P., Porter, L., Morris, L., Mitchell, S., … & Irvine, M. (2014). Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PloS one, 9(7), e102419.

World Health Organization. (2018). International Classification of Diseases, 11th Revision. URL: https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f334423054

Yontef, G. (1996) Shame and guilt in Gestalt Therapy. In R. Lee & G. Wheeler (Eds) The Voice of Shame. San Francisco: 390. pp. 370-371.

Zinker, J. (1977). Creative process in Gestalt therapy. Brunner/Mazel.

Gestalt Therapy: The Paradoxical Theory of Change

Since its founding, Gestalt therapy has been at odds with the dominant medical and psychiatric paradigm of therapeutic change. In the 1970s and early days of its development, the founders of this therapeutic modality, Fritz & Lore Perls and Paul Goodman crystallized the concept of change in psychotherapy through the work of Arnold Beisser, who named this theory the Paradoxical Theory of Change.

“[T]hat change occurs when one becomes what he is, not when he tries to become what he is not. Change does not take place through a coercive attempt by the individual or by another person to change him, but it does take place if one takes the time and effort to be what he is – to be fully invested in his current positions. By rejecting the role of change agent, we make meaningful and orderly change possible.“

Beisser (1970)

Humanistic and existential approaches to psychotherapy emphasize the movement in the here-and-now in the therapeutic relationship. The therapist does not assume the role of fixer or changer but pays attention to the existential meeting with the client. Attunement to the therapeutic situation enables the client and therapist to study and appreciate the phenomenon of their co-created field, which is the physical and emotional environment. In this environment, suffering (or pathos) is felt, grasped and seen. This process of inquiry into pathos is the essence of psychopathology.

People do not change by trying to be who they are not.

Change does not happen through striving or coercion—the person who abandons attempts to disown parts of themselves and tries to change experiences the shift. Hence the paradox, to change, one first seeks to refrain from jumping into influencing change.

The person seeking change in therapy is in conflict, constantly thinking of moving between what they “should be” and what they think they “are”. This dichotomy of personhood is brought to light experientially in therapy. From staying with the discord, the client finds integration.

The Gestalt therapy process is experiential. We use experiments so that clients can learn with an embodied experience. The embodiment of the experience kicks of a cascade of real, percievable change, where the split parts of the self is actualizes into an evolved version. Perls alludes to this spontaneous change in this passage:

[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 sobusy projecting themselves as this or that. This is again the curse of the ideal. The curse that you should not be what you are. (Perls, 1969 p.39)

Reference

Beisser, A. (1970). The paradoxical theory of change. Gestalt therapy now, 1(1), 77-80.

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

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.

The Fertile Void, Creative Indifference & Gestalt Psychotherapy

In his book Schöpferische Indifferenz, philosopher Salomo Friedlaender (1918/2013) opens with [1] & [2]:

Creative Indifference, individual: please don’t immediately misunderstand that first word! It does not mean an individual human being, […], nothing individual at all, but the whole, but not objectively, but subjectively, a creative pathos, the will, the decision, freedom, exemption of the ‘inside’ from utter isolation, of all dividuality —when only this freedom enables everything isolated to be governed, a creatively living identity. […] (O)ne can only give this to oneself—but otherwise one is only an illusory self.

Salomo Friedlaender, 1918/2013, p. 89 (Translated from German)

In the years post WWII, a German-born jewish psychotherapist & psychiatrist, Friedrich (Frederick) Salomon Perls, with his wife Laure, put together (perhaps gestalt-ed) the foundation of a therapeutic modality now known as Gestalt therapy. They were literally refugees in South Africa at that time. Perls drafted out gestalt therapy philosophy in his first book entitled, Ego, Hunger and Aggression (Perls, 1942/47). In this book, philosopher Salomo Friedländer‘s concept of Creative Indifference”.

Creative Indifference, in Gestalt therapy circles, is also given the terms the Fertile Void and the Zero Point. This is an essential aspect of Gestalt therapy. It is also an abstract concept that deserves attention. Therapists who take the time and space to chew on this concept actually grow as therapists. This is how relevant creative indifference is to our vocation. The very fact that Perls started his first book by explaining Friedländer’s work in its first chapter indicates its relevance.

It is my pleasure, with this blog post, to give highest esteem and admiration for Dr. Amendt-Lyon for this keynote lecture at the Gestalt Conference 2019 in Budapest. I was there, alongside about 800 participants, listening to this lecture. Little did we know at that time that this gathering of international gestalt therapists would precede the unfortunate COVID-19 pandemic that would upend the world we thought then we knew.

Below is a bunch of notes and the transcript of her lecture. I figure that this is necessary, lest the video goes astray.

Transcript (Key notes)

When Fritz Perls wrote Ego, Hunger and Aggression, he stated, “for a long period of my own life, I belong to those who, though interested, could not derive any benefit from the study of academic philosophy and psychology until I came across the writings of Sigmund Freud, who was then still completely outside academic science, and S. Friedländer’s philosophy of creative indifference.”

creative indifference, ego hunger aggression, perls
Ego, Hunger and Aggression, page 13

Perls had several reasons for finding the psychoanalytic system incomplete and faulty. First, for treating psychological facts as if they existed separately from the organism. Second, for using linear association psychology as the foundation for their forward dimensional system, and third, for neglecting an important phenomenon, differentiation.

To correct this third fault, Perls intended to apply differential thinking which is based on Friedländer’s theory of creative indifference.

[…]

Experimenting — A familiar approach to creative indifference and differential thinking

Experimenting allows us as therapists to be learners, to take risks, to bearing, but also humble and clumsy make mistakes and admit them, and especially to be able to attune ourselves to our patients while still remaining in touch with our own perceptions.

From this perspective, an experimental attitude is not only an antidote to narcissism but it also prevents us from producing premature answers to complex questions. It stops us from knowing it all. To me, this is the basis for working creatively. We take into account the patient’s experience as well as the therapist’s, and then we explore the situation they create together.

(A)n experimental attitude is not only an antidote to narcissism but it also prevents us from producing premature answers to complex questions. It stops us from knowing it all.

This makes the field more complex the patient and therapists are interacting each with their own polarities interests motivations experiences and needs.The patients polarities don’t exist in a vacuum. They aren’t the object of an examination, but rather emerge within the context of the therapeutic relationship within a joint situation. This experimental approach turns the therapeutic situation into the kind of fertile void from which the surprising and enriching interplay of polarities can emerge. Novel ways of meaning-making stimulating awareness and connecting to one another are supported. This is the light-footed calibration and balance of all aspects of ourselves in relation to one another being of the field; not digging in our heels in stubborn persistence in isolation and prefabricated assertions.

Embarassment is the boundary state par excellance

Part of the journey toward mutual meaning-making is experimenting with embarrassment. Embarrassment which Laura Pearl’s called the boundary state par excellence in which we have one foot in the familiar and one foot in the unknown; a fine example of balancing and calibrating polar opposites. It’s a little bit the way I feel now not really being able to see you, being mildly blinded but still talking and hoping that you’re staying with me.

If we can stay with our embarrassment, our clumsiness, our awkwardness, then we can make contact with what is different for the other, and as we allow ourselves to stay with this experience the boundary of what is accessible expands. We don’t acknowledge our embarrassment, but rather remain within our familiar structures, then we may have the feeling of security but the the price is costly. We won’t contact the novel, we won’t learn anything new, we won’t grow. If patients are struggling with leaving their comfort zones and reluctant to familiarize themselves with the unknown, I’ll often encourage them to embody their dilemma by standing up and playing around with the boundaries of the carpet in my office. Virtually with one room one foot on the carpet and,On the wooden floor, representing the familiar and the unknown. Standing up moving around physically embodying different stances often affords them better awareness of their inflexible polarities and entices them to try out new more satisfying calibrations.

[…]

What are exactly creative indifference and differential thinking, polarities, Zero point or pre-difference, degrees of differentiation.

In a chapter written by the German Gestalt therapist, Ludwig Frambach called the world of nothingness Salomon Friedlander’s creative indifference that I translated for the book […], Frambach put forth that Friedländer’s basic concepts. Creative indifference and polar differentiation mark the beginnings of Perls reflections on therapy theory. […]

Background of Friedländer’s life.

He was born in 1871 in Golans, which is now Poland. He was a German-Jewish philosopher and satirist. […]

With a good measure of black humor. Friedländer wrote, very absurd and popular. Avanga poetry and prose under the name Mynona, which is the German term for anonymous (anonym), written backwards. It seems that Mynona was Friedländer’s alter ego. His dissertation focused on Schopenhauer and Kant. In 1906, he moved to Berlin where he was very comfortable in expressionist bohemian circles among artists and intellectuals.

In 1933, he fled from the rising Nazi movement to Paris where he was very ill for many years and this ironically prevented him from being deported. He died in Paris in abject poverty in 1946.

As far as I can could determine except for two of his novels, none of his writing has been translated into English. So anything you read in English of his philosophy is been is in German or another language.

In Ego, Hunger and Aggression, Perls mentions that there’s no such thing as objective science, that all observations, including those made by scientists, are impacted by particular interests preconceptions and an attitude, largely unconscious, which proceeds selectively. He emphasizes that human beings are indifferent to and uninterested in what they subjectively experienced to be not differentiated.

“Indifferent” refers to being disinterested without prejudice or preference, impartial, unbiased.

“Indifferent” here refers to being disinterested without prejudice or preference, impartial, unbiased.

I’m using the term indifferent to mean not differentiated, capable of development in more than one direction. Being disinterested underlines the absence of prejudice or selfish interests, whereas being uninterested refers to aloofness. So disinterested and uninterested are not very good synonyms because uninterested rather means “I don’t care. I have no interest at all.”

The Zero point, null or naught, is both a beginning and a center like with positive and negative numbers. Perls finds that it’s natural for human beings to think in opposites.He says differentiation into opposites is an essential quality of our mentality and of life itself. Our systems revolve around the Zero point of normality or health. For example, differentiating into two opposites, such as plus and minus, or pleasure and pain.

The way we think in opposites is important and depends on the context. Opposites Perls says a more closely related to one another than each is related to other concepts, such as black and white within the context of color.

Differential thinking, which is a term that Perls coined is the insight into the working of such systems. We would have no concept for day if we didn’t have night as well.

Perls said instead of awareness sterile indifference would prevail. So in Friedländer’s theory it’s important to distinguish between a fertile void and an infertile one.

Creative indifference and being interested

Creative indifference must be distinguished from uninterested detachment from the “I don’t care” attitude. If we’re to perceive an appreciate a phenomenon, it must be different from something else. And as we try to disentangle thoughts into correlative pairs, the unity of polar differentiation, the middle point, or indifference, remains elusive.

We can’t grasp it.

Our focus lies, rather, on the poles than on the indifference.

In this indifference lies the real secret — the creative will, the polarizing one itself, which objectively is absolutely nothing. However, without indifference, there would be no world.

Friedländer says, “yet in this indifference lies the real secret — the creative will, the polarizing one itself, which objectively is absolutely nothing. However, without indifference, there would be no world.”

Indifference, or the naught zero of the difference, is the center of creativity. The original source, the subjective heart of the world, according to Friedländer. External and objective is what can be differentiated into polarities, but the internal part is the indifferent, weighty world of nothingness.

Originally in German, das Weltenschwangerenichts, which means literally, the nothingness that gives birth to worlds.

…The nothingness that gives birth to worlds.

This picture is a Zen calligraphy of the word “mu” which incidentally refers to the same concept of nothingness.

Friedländer emphasizes the lively creative center by referring to it with a multitude of terms ,ego or ego heliocentre, self, being, subject, individual identity, person, mind, soul, absoluteness, the symbol for infinity insistence will or freedom. […] Perls used in writing Ego, Hunger and Aggression, center, zero point, equilibrium, naught, void, pre-difference, holes, balance and so forth.

Friedländer won’t be restricted to one term for what is indescribable and perhaps this joy in circumscribing a definition influence Perls’ diverse descriptions of the concept of self. Because in Perls, Hefferline and Goodman (1951), he refers to it as the artist of life, the function of contacting, the actual transient present, the system of present contacts, and the agent of growth, the complex system of contacts necessary for adjustment in the field.

Creative indifference tends toward creative development.

Friedländer are found indifferentiation to be liberating, for it allowed a person to become centered, able to integrate a variety of experiences and contents, to tolerate ambiguity and ambivalence, and to find what he called, their heart. By embracing a diversity of possible phenomena, we can actively engage in creative production because creative indifference tends toward creative development.

In more simple terms, arising from an indifferent middle point, we can embrace and balance both polar opposites and calibrate our actions, depending on what the situation calls for, demand characteristics of the situation; Gestalt psychologists would say.

Polarities are mutually related, not contradictions

Polarities shouldn’t be treated as mutually exclusive contradictions, but rather as polarly differentiated units of opposites. They are mutually related and can be flexibly centered according to their zero point. Between the polarities there’s a tension, a kind of magnetism an appropriate Gestalt therapy example of this is what we call, present-centeredness.

According to Perls, the present is the ever-moving zero point of the opposite’s past and future. It’s not static, or absolute, but a constant plane with relativity, a balancing, a back-and-forth of meaning-making.

The Field, the Context

Opposites emerge from the pre-different. Differentiation begins at the zero point, and in choosing a zero point, the field is a pivotal factor.

Creative indifference is full of interest, extending towards both sides of the differentiation. It’s by no means identical with the absolute zero point but will always have an aspect of balance. Thus by having the field, the context, we can determine the opposites, and by having the opposites, we can determine the specific field.

[CASE STUDY at timestamp 19:56]

Ludwig Frambach also finds evidence for Friedländer’s differential thinking in such gestalt concepts as as self and middle mode. In Perls, Hefferline and Goodman you’ll read self is spontaneous middle and mode as the ground of action and passion and engaged with its situation as you, I and it. The spontaneous is both active and passive both willing and done to, or better, it is middle in mode, a creative impartiality, a disinterest, not in the sense of being not excited or not creative, for spontaneity is eminently these but as the unity prior and posterior to activity and passivity containing both.

In the English language there hardly exists any middle mode, it doesn’t imply any action on the self such as retroflection. The middle mode means rather than whether the self does or is done to. It refers to the process itself as a totality. It feels it as its own and is engaged in it. So perhaps it is the English expression, “to address oneself to”.

The fertile void, the impasse

The fertile void, which Perls seems to often use almost interchangeably with creative indifference, also appears in his five-layer model of neurosis. Following the phoney and phobic layer there’s an impasse, a kind of blockade in which former foreground-background differentiation dissolves into chaotic disarray. The fourth layer, resembling a vacuum, is referred to as the death layer, also the fertile void or implosion.

Here the indifference of nothingness, the creative ground can be experienced affording a person the opportunity to readjust a one-sided identification to discover unknown aspects of himself or herself, to experiment with calibrations of extremes, and basically recovery mode. Then the self can be spontaneous in its agency integrating previously rejected or undiscovered aspects of the personality, balancing them appropriately with what a person already accepts and identifies with. This is the emergence of the explosion layer.

[…]

Is working with creative indifference a methodological question an approach that gestalt therapists adopt today?

It’s often the case that people who seek psychotherapeutic help find themselves off balance, out of touch with their emotions, caught in a rut of routine that’s limiting and frustrating… and a person who’s suffering from an urgent problem will most likely not be ready and willing to immediately begin the search for aspects of their perception that have been avoided, overlooked, devaluated or which are potentially shameful. They may say, “This is who I am. This is how I am. I’ll never be able to change.”

Therefore a trusting mutually appreciative therapeutic basis is important before we embark on the adventure of exploring unknown territory. As usual, we’re accompanying our patients, not forcing our insights and interpretations down their throats. We all know that the need to change and grow is often as strong as the need to hold onto our familiar ways of dealing with life.

A part of our task is to stimulate our patients’ curiosity and help them complete the picture between the familiar pole and the unknown one taking the many small steps in between. And this is involves what I often call, “rewinding their film”.

Not being aware of things that might shed light on our situation is one way of avoiding a decision that could bring about change. So our job is to keep the dominant pole in awareness while helping the patient to realize that there’s a polar opposite out there that’s being neglected, and the that these polar opposites are parts of a whole aspect of the same reality. We can help them to realize that restricting themselves to one pole not only keeps them in an unsatisfying situation but also robs them of the opportunity to test more enjoyable and satisfying ways of being. A part of our task is to stimulate our patients’ curiosity and help them complete the picture between the familiar pole and the unknown one taking the many small steps in between. And this involves what I often call, “rewinding their film”.

Not knowing for sure, is helpful

To this effect, an indifferent attitude and approach of not knowing for sure is helpful. Not knowing for sure implies that there are countless ways of dealing with a problem, not just one. This takes into account the uniqueness of each patient and each therapist and unique this of the way they work together.

Moreover, the rest of the field — the current context — must be considered, such as life circumstances, and the social, financial, and political situation.

Friedländer’s equilibration of polar opposites certainly influenced Perls’ work with polarities, as well as the gestalt therapy concept that human beings create their own reality. Equilibriating or centering implies appropriate adjustment to a situation. Balancing the predominant with the neglected aspects, transforming a feudal struggle into productive cooperation. Turning a standoff into enjoyable interplay and enriching recombination.

[…] Instead of rigid and isolated dualities, we have flexible and related polar opposites.

The fertile void is insistent, and it only becomes existent through the will of a person.

If the center, self, zero point or fertile void is indifferent or undifferentiated and everything possibly human is a priori contained in this, then the fertile void can be considered to be an inexhaustible source of energy and possibilities. Friedlander calls this fertile void insistent, and it only becomes existent through the will of a person.

The distance from the zero point of one’s decision corresponds to a distance from the same zero point in the direction of what this person is avoiding or not embodying. From this perspective, if one’s very essence is considered to be invulnerable, all movements away from the center seem to be relative differentiations.

Then all the decisions one makes, all the undesirable developments, all the injuries and traumata can be worked through in light of an opposite force that can be accessed. To me, this is a very life-affirming position and it’s vital for our work as gestalt therapists and appeals to me on the one hand — but on the other hand, I must admit, that I sometimes feel restricted by Friedländer’s elusive concepts.

In my perspective, a contemporary gestalt therapeutic concept of the fertile void is not just about concentrating on a patient’s polarities and calibrating them because this reflects the one person psychology of the past.

Contemporary perspective is multidimensional and highly relational. I tend to envision a three-dimensional conglomerate of related parts that can be jointly reconfigured many times over. Rather a sculpture and installation or a group of items placed together, meaningfully then a drawing because the parts need to be movable. So let’s not just limit ourselves to focusing on the calibration of polarities, but also on the additional dimensions of what we as therapists bring into the equation. The relational present of the patient as well, the dimension of time and many other influences on the present situation.

Contemporary perspectives of Gestalt therapists

I’d like to mention the work of several gestalt therapists on who’s concepts are drawn and reflecting on the fertile void Joseph Zinker (1977) on polarities and experiments, Franz Staemmler on cultivated uncertainty, Laura Perls on meaning-making and embarrassment, Richard Wallin on Gestalt theoretical principles and Jean-Marie Robine, on intentionality and the situation.

Zinker sketched his notions of a healthy and a pathological self-concept in terms of polar opposites and aware versus unaware experiences. This is a sketch of his of healthy self-concept where. The aware part is white and shows the polarities that are accessible to an individual and the shaded area is his blind spot. So the shaded area is rather small.

J. Zinker

The pathological self-concept is here. It shows a rather large shaded area of blind spots and things that aren’t accessible. It shows inflexibility and unawareness.

Despite the fact that many of us today deal with categories of healthy and pathological as being on a much more fluid spectrum and rather founded on relationally-based aesthetic criteria than individual pathology Zinker’s sketches enable us to understand that embracing contradictions ambivalence and ambiguity and ability to experience relationships between these internal aspects, help to keep us balanced.

Here he shows that if we stretch the polarities in one direction it automatically stretches also in the other direction.

When Frank Staemmler refers to cultivated uncertainty as an attitude for Gestalt therapists, that reflects the dialogical approach, it implies that we must be aware of our uncertainty regarding our own attribution of meanings to patients. Looking closely, we also find it in what Laura Perls called the three E’s of therapy: existential, experiential and experimental. According to Laura Perl’s we’re constantly creating out of nothingness psychotherapeutically, artistically, or scientifically with insights and realizations, with the re-configuration of chaos and ugliness into something new and meaningful.

Following the thoughts of Laura Perls and Paul Goodman about aesthetic qualities being inherent to human experience, Michael Vincent Miller (2003), in a beautiful article called Notes on Art and Symptoms, reminds us that Gestalt therapy theory reflects concepts where familiar with in the field of art. Good contact can be seen as an aesthetic activity and these activities demonstrate good form and others beautiful, in the sense of being meaningfully organized and integrated.

It’s precisely the integration of seemingly incompatible and disparate experiences, the ability to deal with the challenges of ambiguity and complexity, the skill of being able to embrace differing perspectives and contradictory alternatives with ease and comfort, that’s our goal and therapy, for they afford us meaning in a sense of being one with ourselves in relation to others. Such ongoing gestalt formation belongs to the essential goals of therapy.

Both art and psychotherapy thus reflect the human tendency to form and transform familiar elements and thus bring about new information to transform one’s own experience in a world in a way that allows for integration by creating something unique and meaningful. The form is given to human experience. It’s precisely the integration of seemingly incompatible and disparate experiences, the ability to deal with the challenges of ambiguity and complexity, and the skill of being able to embrace differing perspectives and contradictory alternatives with ease and comfort, that’s our goal and therapy, for they afford us meaning in a sense of being one with ourselves in relation to others. Such ongoing gestalt formation belongs to the essential goals of therapy.

To Laura Perls, we human beings are always involved in the polarities of being unique and being mortal. The first gives us the impression of incredible significance. The second the feeling of fear and frustration and the human condition is a continuous balancing of the tension between these poles.

Richard Wallen convincingly tied gestalt psychological principles in particular gestalt destructuring and formation to the effect of practice of herself therapy. He suggested ways of interest intervening, that would destabilise a blocked unsatisfying life situation and support the patient in reconfiguring the field into a meaningful whole. He gave great attention here to bodily awareness and careful experimentation with the perception of and movement. Although he doesn’t speak in terms of fertile voids or polarities, he does focus on deconstructing an imbalanced field and reassembling it beginning fresh to allow a meaningful stop to emerge and this brings me to Jean-Marie Robine’s profound work on taking shape.

An article published in 2003 or being focused is his attention on the therapeutic situation and the importance of the unoriginal pre-differentiated phase the vague, confused, diffuse or chaotic phase of four contacts before a figure clearly emerges. He states what we call the “social situation” is a structure of possibilities that I create with the other, and which in turn creates us respectively. Clearly, the therapeutic situation defines my presence and my intention as a psychotherapist just as it defines the presence and expression of my client.

The concept of the self in gestalt therapy tends to focus on someone’s I am, a narrative identity. Which is one of the possible declensions of the personality mode of the self. A result of an experience in a certain situation.

Contrary to gestalt’s temporalized and delocalized way of approaching the concept of self narrative identity tends to be static and perceived as a structure or character. It gives us the impression of fixity, suggesting that the self is something permanent or stable. So this need for stability and continuity forecloses access to the novelty of situations and opens us to the repetition of experiences, including the most painful ones. So if a patient has some presuppositions about themselves or us as a therapist, then it prevents this person from sensing the situation, and what’s really going on. They aren’t of the situation. So, this might suit their comfort zone and need for security and certainty, but instead of staying in contact with their immediate sensations and perceptions, however vague, confusing or contradictory, we often tend toward what Robine calls premature differentiation, which is based on a similar premature individuation.

So Robine compels us to linger in this phase of four contacts or skillfully return to it with our patients. So we can enable them to access novel aspects of our meeting and to avoid these over-hasty assertions or premature intentionality, because intentionality proceeds, what forms a person’s conscious intent.

We can seek it in the therapeutic situation by expressing how we, as another in the presence of our patient, are mostly impacted by this encounter how we resonate and experience it. We begin with experience with what is sensed and perceived in the moment as opposed to our assumptions of the other.

What I sense and intuit when together with someone helps me to understand what’s in the field. The way I’m affected by a patient gives me information about their intentionality, and how I act on this, can support its differentiation and open the person to new possibilities. Here, now, next tells us that in the present moment, there’s an orientation, an imminent direction, an implied future.

Robine talks about the metaphoric construction site, which is reopened with each encounter giving us novelty surprises and touching the unknown. And it appears to me that it’s just this metaphoric construction site –I love that expression — Is the rich source of all possibilities and creative indifference.

This view has implications for the effective practice of gestalt therapy. Robine reminds us to attend more carefully to the phase of the process of construction and deconstruction of gestalts. The emergence of figures against the background. As he said at the fertile exit from the void, that according to Perls, defines the zero point, the before and after of every gestalt.

So instead of taking our patients presenting problem, or the figure they decided to work on it face value, it’s our task to introduce a measure of uncertainty or doubt, maybe irritate them. Interventions are called for that enhance the vagueness. They can help to work back to the id of the situation, to an undifferentiated state from which together we can allow gestalt construction and deconstruction to an unfold.

As Robine says, this complexifies intentionality by amplifying confusion. This is one of the gold nuggets in this article, it’s wonderful. So we joined the revisit the elements that contributed to the emerging figure. We disentangle the material, we try to reconnect it, we restructure it, through the presence of another in a way that takes our own situation or present and our presence into account. We afford the patient different information adding complexity and the reorganization. The process of reconstruction allows for novelty and the reorganization of a dysfunctional situation. So this redistributes the excitation. It reorients the direction of meaning. We extend an invitation to play. We play with the situation until work becomes played.

Enabling possibilities

Therefore our interventions are aimed at enabling possibilities. We collectively disconnect deconstruct de-autonomized we reshuffle and then we reconstruct. We stand by our patients during upheaval and temporary chaos. We contain confusion and seeming incompatibilities. We assist with the new configuration of figures and backgrounds we maintain mobility and flexibility. Our task is not a matter of substituting dysfunctional connections with new more appropriate ones. But it’s much more matter of introducing mobility in such a way that nation’s experience can modify if you can modulate its available and accessible materials into creative configurations themselves, unceasingly renewed. As an old saying goes, “if you give someone a fish then he has food for one day, but if you teach him how to fish then they’ll have food for a lifetime”.

Our patients’ difficulties in living their symptoms and suffering can be seen as the production of figures from the available materials in their backgrounds, it’s a process of gestaltung, of taking shape giving form to something. So we’re engaged in the structuring of the situation. Often we’ll have to interrupt a patient’s prepared narrative or insist on rewinding the film so that we can benefit from the possibilities of an undifferentiated starting point and continuously engaged in the aesthetic creation of meaningful forms.

It’s this undifferentiated location, this vague phase of fore contact, that I relate to creative indifference, it’s the deep well of all possibilities the metaphoric construction site. So my perspective can be summed up as a decidedly relational multidimensional approach our tasks are to intervene in such a way that the rigid patterns of our patients can be softened, their age-old assumptions are reassessed as to their appropriateness to the current situation over hasty narratives are slowed down and explored step by step. A prefabricated solution to a problem is put on hold and the focus is placed on collaborative meaning-making based on aesthetic experiences.

Accordingly, the original situation and materials from which these figures emerge can be jointly perceived, experienced, and reconnected in a novel way, thanks to the sensory experience, immediate emotional reaction and insights of the therapist within the therapeutic situation.

Typical interventions to this effect are:

“I feel as if you’re giving me the answer to a question I haven’t posed yet.” “Let’s rewind the film to the beginning and proceed slowly.” “Tell me more about what you were experiencing before you came to this conclusion.” “How else could we perceive this situation?” “What might we have overlooked?” “Describe your bodily sensations and impulses.” “Do any images arise?” ” What do you smell or taste?” “Who or what might have played a role when this difficulty first arose?” “What’s the opposite of your fearing powerless and being at your partner’s mercy?” “My breathing becomes shallow as I listen to you.” “I feel angry when I hear what you’re telling me.” “I start to feel hypnotized when I listen to you talking without interruption.” “I feel out of touch with you when you talk about yourself in terms of clinical diagnosis.”

Clearly this implies that we’re not working solely with a patient’s polarities, but also with what emerges is figural from the context of our experiences, with our immediate sensory and emotional reactions, our fantasies, with our reflections on the therapeutic relationship and dynamics.

The therapy room has become a multi-dimensional space for creative play and experiments, for novel compositions mixtures and new combinations. We are part of the equation. A creative elaboration of therapy is for the moment real and the game. One which is limited in time, but which has a lasting effect.

We have extended an invitation to play. As psychotherapists, we can assume that if people have learned one-sided view of themselves and others, they can also learn to balance these misperceptions or premature assertions. At times we’re like good parents. We’re attentive to their needs. We offer them a safe space to explore what might feel threatening and encourage them to restructure and reconnect their interpersonal fields. We encourage them to take stock of their current assumptions and models of the world, to test novel ways of construing and discover what’s appropriate to their life here-and-now with a view to what comes next. Thank you for your attention.

creative indifference, gestalt therapy
Creative Indifference & Gestalt therapy. These are my notes on this lecture.

My article on Creative Indifference

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

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

Footnotes:

[1] “Schöpferische Indifferenz, Individuum — bitte nicht sofort ein Mißverständnis bei diesem ersten Wort! Es ist kein einzelner Mensch gemeint, auch nicht die aus solchen Einzelheiten bestehende Menschheit, überhaupt nichts Einzelnes, sondern das Ganze, aber nicht objektiv, sondern subjektiv, ein schöpferisches Pathos, der Wille, der Entschluß, Freiheit, Exemtion des „Innern“ von aller Isolation, aller Dividualität — als diese Freiheit erst befähigt zur Regierung alles Vereinzelten, schöpferisch lebendige Identität. Allerdings, dieses kann man sich nur selber geben — aber man ist sonst nur illusorisch ein Selbst.” (Friedländer, 1918/2013, p. 89)

[2] At this point of writing this article, I am not aware of an English translation of the book, Schöpferische Indifferenz, the quotations I present here are my translated version.

Bibliography

Ament-Lyon, N. (2019). How can a void be fertile? EAGT Gestalt Conference 2019, Budapest, Hungary. https://www.youtube.com/watch?v=kXMw7h5WWds

Friedlaender, S. (1918/2013). Schöpferische Indifferenz. Gesammelte Schriften Vol 10. BoD–Books on Demand.

Miller, M. V. (2003). The aesthetics of commitment: What gestalt therapists can learn from Cezanne and Miles Davis. In Creative License (pp. 153-161). Springer, Vienna.

Perls, F. (1942, 1947). Ego, Hunger and Aggression  ISBN 0-939266-18-0

Perls, F., Hefferline, G., & Goodman, P. (1951). Gestalt therapy. New York, 64(7), 19-313.

Zinker, J. (1977). Creative process in Gestalt therapy. Brunner/Mazel.

Short Definitions of Relatedness and Relationship

Relationship

The relationship is an encounter sustained in the long term, a chain of meetings that includes a shared perspective of shared history and shared present because there is free will to live life together in a reliable relationship.

Relationship presupposes the ability for demarcation and touch, conflict and compromise, mutual empathy and shared reality. Relationships are intentional, lasting and reliable. They include the ability to contact and meet.

Encounter

The encounter is a reciprocal empathic meeting of different persons in the here-and-now—the meeting in which there is contact results in an inter-subjective exchange that is healing.

Contact

Contact is a meeting of separate and concretely different individuals. The perception and bodily experiences of the person and the environment are distinct. The person can distinguish the difference between the inner and outer world and can establish, through contact, identity.

Confluence

Confluence is a form of human co-existence that is unrestricted. It is characteristic of the coexistence of the embryo and its mother.

There is no differentiation in perception of the individual persons in a confluent relationship. In adults, the fusion experiences can be that of the positive pleasurable or negative non-pleasurable kind (Petzold 1993, Volume III, p. 1066).

Attachment / Bonding

Attachment results from the decision to restrict one’s freedom in favour of a freely chosen bonding. To endow an existing relationship with the quality of inviolability through loyalty, devotion, and willingness to suffer.

Dependency

Dependence is a bondage at the expense of personal freedom, which is structurally predefined as a natural “attachment” in children, or attachment-based socially meaningful behavior, for example, in the case of adults in need of care in the immediate vicinity of social relationships and networks. But it can also have pathological qualities such as neurotic dependencies, addiction-specific co-dependencies, and collusions.

Bondage

Bondage involves massive, pathological dependence still exceeding qualities because fundamental rights and rights-violating restrictions of freedom, mental and real deprivation of liberty, when the enslavement occurs (often on a sexual level in pimp prostitution, sadomasochistic dependencies or on an economic basis in debt slavery, blackmail, etc.).

Source

Renz, H., & Petzold, H. G. (2006). Therapeutische Beziehungen–Formen „differentieller Relationalität “in der integrativen und psychodynamisch-konflikttherapeutischen Behandlung von Suchtkranken. Bei www.​ FPI-Publikationen.​ de/​ materialien.​ htm–POLYLOGE: Materialien aus der Europäischen Akademie für Psychosoziale Gesundheit, 13, 2006.

Notes on Field Theory in Gestalt Therapy

The field theory is a gestalt therapy term that warrants interest. Psychotherapy practitioners who consider the field and know how to use this insight in their clinical work can expect better outcome. Lately, there has been “ripples in the field” among gestalt therapy researchers on the topic of field theory and treatment of psychopathological symptoms like anxiety (Francesetti, 2007).

The challenge is in understanding the concept of field in gestalt therapy. The word “field” is associated with different levels of meanings as highlighted by Staemmler (2006). When we consider fields of corn, a football field, a professional field, we may understand the nuances of meaning the word brings. In the scientific arena, we think of magnetic field in physics. In psychology, the field implies mutually interdependent facts or phenomena. The notes below is a summary of the Staemmler article plus my reflections on it.

Field-Staemmler-notes

Download pdf

In the article there is an attempt at formulating an understanding of “field” in gestalt therapy with the use of lexicon of English words. What ultimately happens is a kind of looping of ideas and argument on the subject.

Another approach to understanding Field

from : https://www.youtube.com/watch?v=gyOeo89eFKI

My preference at understanding abstract psychological concept like “field” in gestalt therapy is to use metaphor or what I am calling here “isomorphic universes”. Isomorphism are structurally similar processes that underlie our lived experiences. Observing isomorphic universes, we may be able to understand our human experiences better. This is a way of understanding by feeling as opposed to understanding by explanation with words.

I got this idea to use ants and ant nests as an isomorphic universe to illustrate the field in the world of human experiences after reading Hofstadter’s (1981) charming story, Prelude… Ant Fugue.

Gestalt Therapy Field Theory according to Ants

First is to observe and understand ant colonies:

In this video, the organized nature of an ant colony is compared to human societies except that “this organization does not arise from higher level decisions, but it is part of a biological cycle.” Consider that the field in gestalt therapy is also described as “biological knowledge” (K. Goldstein) and “intra-orgamismic” (Perls and Heferline). This could imply that as humans, we make decisions consciously and are also maneuvered by biological knowledge outside our consciousness.

Ants observed as individuals seem to be autonomous. However when we get a chance to focus on these creatures as a colony, we can appreciate the structure of their “field”. Individual ants as part of the colony react to stimuli from the environment. In contact with a food source or danger signals, the individuals in the colony react somatically. These individuals spontaneously produce pheromones and move their bodies in response to these stimuli. Pheromones and physical contact with each other affect individual ants in the field, which in turn respond and affect the other ants.

Another video about ant colonies.

The understanding of “field” according to the ant colony can be appreciated as mutually interdependent processes that connects the organism and the physical environment. Since it involves mutual interdependence of individuals, we can also see the social aspect of colonies.

When we look at human communities, can appreciate how a person is “of their own field”. Kurt Lewin (1951) used the term “life space (L)” ; the combination of the individual organism (P) with their psychological environment (E) as it exists for this individual.

L=P+E

Consider that for each individual ant (and human) there is a continuous flow of data dynamically being received and presented at the same time from the field and to the field.

Human communities form what Hofstadter (1981) terms “representational systems”, which are “active, selfupdating collection of structures organized to ‘mirror’ the world as it evolves”, like countries, organizations, cultures, families. These systems appear to define themselves through psychological decision making of individuals. Psychological decisions made are in response to environmental and social interactions. The environment and societies return feedback. The environment and societal influences affect the individual (P) physically. Individuals act in a way motivated by own needs in response to their psychological environment (E). The presence of this individual in the field is their life space (L).

5 Principles of Field in Gestalt therapy

Parlett’s (1991) 5 principles deepen our understanding of field in Gestalt therapy. These are the principle of

  1. Organization,
  2. Contemporaneity,
  3. Singularity,
  4. Changing process,
  5. Possible Relevance.

In our ‘representational systems’ as with ants in ant colonies, we can perceive how the field 1. organizes societies and individuals in their roles. We can see 2. how individuals in the system act in the here-and-now, as a consequence of the field. This is not a matter of cause and effect but rather a consequence of being of or belonging to the field. 3. Each individual’s life space is unique to each situation. 4. the field changes continuously (the time element). 5. Everything that the individual does and feels has possible relevance to the field. Everything in the here-and-now is inherently relevant.

“The five principles laid out above are overlapping and not discrete. Rather they are five windows through which we can regard field theory, exploring its relevance in practice.”

Parlett

The 5 principles are useful in our work in gestalt therapy. The therapist stays in the here-and-now of the session and is aware that everything observed is of the field.

Using the Field in Practice

A therapist’s ability to use the field is an asset that contributes positive client outcomes.

Consider ants again. If an ant decided to abandon colony life, what would its fate look like? The field around this ant changes. It leaves the physical environment of the colony that supports its source of food and protection. This isolated ant is not expected to thrive.

Human beings, unlike ants, have more complex psychological structures. We are able to introspect and reflect on ourselves. We have a sense of self. Often this sense of self or identity leads us to deny the existence of the field. Remember that the field is not the same thing as a community or a system. An individual may be active in a community or a group but be simultaneously in conflict with the needs that emerge from the field. This happens out of awareness.

The field includes the mutually interdependent processes that form or create — the word in German is incidentally, gestalten — the representational system or community.

A person who is not adequately or appropriately supported by the field creatively adjusts to their environment.

Psychopathology in relation to the Field

Like many of my gestalt therapist colleagues, I am no fan of diagnosis. The term psychopathology used here is necessary to describe symptoms experienced by clients seeking therapy. However, let us consider the following symptoms and their interrelation between an organism and its field.

The experience of being separated from the system: The organism finds itself as part of an over-exposed and unprotected field. There is a pervasive feeling of anxiety and panic.

The experience of being abandoned and forgotten by the environment: The organism is part of a lacking, unsupportive, unnourishing field. The experience may feel like depression.

The experience of being in an intrusive environment. The organism finds itself in a field of isolation as a means of protection from being sapped of resources. The experience is of being isolated and schizoid.

The experience of being in a hurtful or dangerous environment. The organism finds itself of a fearful field. There is a need to dissociate the self from the field.

The experience of being squeezed out or non-existent in the environment. The organism finds itself of a field in which the needs of the organism are unworthy of attention, because survival the system is more important. The experience may feel like co-dependency.

Observing the field in gestalt therapy as a way to understand psychopathological states requires the therapist to engage in aesthetics. This is counter-intuitive and often a odds the medical model of psychiatry. Using the field, we do not diagnose the client as a person in isolation. We take the holistic view of the field and the organism as part of it.

Application of Field Theory in Practice

There exists writings on how the field theory in Gestalt therapy is experienced in psychotherapeutic practice, on how the pathos of the field, emerges during the therapeutic encounter.

In my recent papers, I have taken on Francesetti’s illumination on sensing the “aesthetics of the field” in therapy. These papers can be accessed below:

Pain and beauty: from the psychopathology to the aesthetics of contact1
Gianni Francesetti

Nicole Chew Helbig British Gestalt Journal 31.1 Digital Pdf Full Copy 4

A Psychotherapist S Lived Experience In Session With An Asylum Seeker And Translator An Autoethnographic Case Study

Bibliography

Francesetti, G. (Ed.). (2007). Panic Attacks and Postmodernity. Gestalt therapy between clinical and social perspectives. FrancoAngeli.

Hofstadter, D. R. (1981). Prelude… Ant Fugue. In The mind’s I: fantasies and reflections on self and soul. Dennett, D. C., & Hofstadter, D. R. (Eds.).Harvester Press. p. 149.

Lewin, K. (1951). Field theory in social science: selected theoretical papers (Edited by Dorwin Cartwright.).

Parlett, M. (1991). Reflections on field theory. The British Gestalt Journal, 1(1), 69-80. URL: http://itgt.com.br/wp-content/uploads/2014/08/Reflections-on-Field-Theory-Parlett.pdf

Staemmler, F. (2006). A Babylonian Confusion?: On the Uses and Meanings of the TermField’. British Gestalt Journal, 15(2), 64.

Diagnosis of Obsessive-Compulsive Personality from the Gestalt Therapy Perspective

The DSM V describes obsessive-compulsive personality disorder (OCPD) as a pervasive pattern of preoccupation with

  • orderliness,
  • perfectionism, and
  • mental and interpersonal control.
obsessive-compulsive treatment

Individuals with presenting phenomena 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 of being in a constant state of obsession-compulsion is chronic inefficiency in doing daily tasks resulting from the preoccupation on distracting details or rules and schedules which leaves the main tasks undone. The quest for having tasks done perfectly also leaves tasks unfinished. While everything takes longer to complete, there is also an added obsession with work and productivity. This leaves the individual with little energy left for leisure activities and relationships. Relationships eventually suffer because there is a tendency to be overconscientious and inflexible, oftentimes about matters of ethics. Many individuals with OCPD tend to hold on steadfastly to religious or ideological stance. They may also have fixed ideas of how things should be done while not delegating their work to others.  Some individuals may exhibit tendencies of holding on to unnecessary objects or  being miserly. A certain feature of this personality style is the display of stubborn rigidity. 

Obsessive Compulsive Personality Disorder Explained with Gestalt Therapy 

Looking at this condition through the gestalt therapy lens, we may be able to appreciate the complexity of the client’s 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 to avoid touching 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. The behavior and thoughts are triggered in order to avoid the possibility of situations that leads to helplessness. This requires the attempt at 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. The need would be to hold on to the habitual thoughts and action as if these were 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 or 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. 

Treatment Focus

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.  

Phenomenology

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

Sources

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. 

Resnick: Gestalt Therapy Principles in Today’s Context

What is gestalt therapy? Resnick explains gestalt therapy principles in just 30 minutes with this video. Is Gestalt therapy for you? Watch this.

 

“The relationship is not as important as the research shows but what happens in the relationship. When there is an interaction between therapist and client.”

This is the best video resource to understand, ” what is gestalt therapy?”.

 

 

An Introduction To Gestalt Therapy Theory from GATLA Videos on Vimeo.