Amendt-Lyon: Creative Indifference & Gestalt Psychotherapy

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.

Nancy Amendt-Lyon

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 that whether the self does or is done to. It refers to the process to itself as a totality. It feels it as its own, and is engaged in it. So perhaps it in 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 phony 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 with our job 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 is 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, the social, financial, political situation.

Friedländer’s equilibration of polar opposites certainly influenced pearls 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 zerp 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 are 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 the healthy self-concept where. The aware part is white and shows the the polarities that are accessible to an individual and the shaded area are his blind spots. 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 things that aren’t accessible. It shows inflexibility and and unawareness.

Despite the fact that many of us today deal with categories of healthy and pathological as being on a much more fluid the 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 the 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 Pearl’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. 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, 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 de-stabilize 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 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 profound work on taking shape.

In 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 contact 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 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 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 in the situation, 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 contact 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 by 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 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 the new configuration of figure and background 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 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, 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 psychotherapist 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.

Bibliography

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

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 York64(7), 19-313.

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

Petzold: Short Definitions of Relatedness in Relationship

Relationship

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

Relationship presupposes the ability to 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 an exchange, that is healing.

Contact

Contact is described as a meeting of separate and concretely different individuals. The perception and bodily experiences of the person and the environment are separate. The person is able to distinguish the difference between the inner and outer world, and is able to 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 is the result of the decision to restrict ones freedom in favor 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 it is 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, 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 Gesundheit13, 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

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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

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, recommended to me by my colleague and research partner, G. Spano.

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 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 deepens 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 consequence to 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 for 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 again ants. If an ant would 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 means of describing symptoms experienced by clients seeking therapy. However, let us consider the following symptoms and their inter-relation between organism and it’s 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 finds itself 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 of a field of isolation as a means of protection from being sapped of resource. 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.

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.

Parlett, M. (1991). Reflections on field theory. The British Gestalt Journal1(1), 69-80.

Staemmler, F. (2006). A Babylonian Confusion?: On the Uses and Meanings of the TermField’. British Gestalt Journal15(2), 64.

Young & Lester: Gestalt Therapy Approaches to Crisis Intervention with Suicidal Patients

This article explains the use of Gestalt Therapy for crisis intervention with patients who are suicidal. The article by Young & Lester (2001) , provides for good information on the topic. I shall list the following points presented by the authors.

Gestalt therapy is an ideal method for dealing with crisis situations. This is because of the methods focus on the here-and-now and being present for the patient. Working with suicidal patients in crisis, being empathic and listening is everything. Accounts from patients in dire situations are filled with expressions of loneliness and helplessness. Hence being with someone who is actively listening without judgement is precious.

Read also : suicide crisis intervention: working with …

Steps involved in working with patients who are dangerously suicidal involve:

  1. Acknowledge of the suicidal ideation. To offer a listening ear and accepting that the client is in distress and has in mind to take his/her own life.
  2. Exploration of the suicide plan. This means talking openly with the patient about details of his/her ideas of the suicide wish.
  3. Exploring feelings of anger and sadness underlying. When we work through these feelings more emotions are discovered, and these include helplessness, shame and hopelessness.
  4. Bringing to the patient’s awareness that a part of him/her still wants to live. Brining to light this ambivalence is an important step that could radically diminish the wish for suicide.
  5. Giving voice to the patients psychological struggle. Giving a listening ear to the patient’s psychological difficulties frees the person of the guilt of having these painful thoughts and feelings.
  6. Understanding of major issues. With his/her sharing of the issues, both therapist and client get insight and understanding of what is happening to the patient.
  7. Addressing their underlying loneliness. The therapist’s witnessing without judgement alleviates the loneliness felt by the patient of living with the struggles.
  8. Clarity in their responses to feeling questions. The therapist guides the client to get in touch with feelings.
  9. Awareness of how the patient is repressing emotions.
  10. Experiencing repressed emotions. These emotions are very difficult and oftentimes painful. When these are expressed, the distress is followed by relief.
  11. Grounding. As the emotions subside, grounding is the act of bringing the client into the here-and-now in the interaction with the therapist.
  12. Acknowledgement of relief. The relief felt from expressing these emotions and grounding is given some attention so that the patient is able to take in the phenomenon.
  13. Self acceptance and understanding. Therapist and client spend some time expressing gratitude for what they have experienced together.
  14. Exploring options for the future.

Read more: Suicide crisis intervention: working with people who are in danger of taking their own lives.

Bibliography

Young, Lin & Lester, David. (2001). Gestalt Therapy Approaches to Crisis Intervention With Suicidal Clients. Brief Treatment and Crisis Intervention. 1. 10.1093/brief-treatment/1.1.65.

Diagnosis of Obsessive-Compulsive Personality from the Gestalt Therapy Perspective

Obsessive Compulsive Personality Disorder explained and treated with Gestalt Therapy method.

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

  • 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. 

Experiential psychotherapy sessions bring lasting effect

I mentioned in the first page of my website that clients can expect motivating, fun and experiential psychotherapy sessions. While it is for most clients the road to therapy is wrought with painful experiences and difficulties, being in therapy is about learning. The learning one gets from gestalt psychotherapy is not the kind of cognitive learning one expects to get at school. Rather, in experiential sessions, one learns procedurally. The experiments and role playing enables the clients to embody new ways of being. This kind of learning takes no effort. This kind of learning is integrated and permanent. The road to this kind of learning is also playful, touching and motivating.

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.

Gestalt Therapy is about Action and not Simply Talk

If the process of psychoanalysis, as defined by Freud’s Anna O., defined as a “talking cure” (Breuer & Freud, 1893/2009), what about Gestalt therapy?

The curative process of Gestalt therapy is action. Polster and Polster (1974, p.233-284) devote a an entire chapter on their book to the concept of “experimentation” as a therapeutic process. During a gestalt therapy session, the client is encouraged to try out new behaviors, and stay with feelings which he/she would otherwise not dare to (or is not allowed to confront) in daily life.

More than just a “talking cure”, gestalt therapy is like a “doing cure”.  The client talks, but his/her talk is not merely a narration or a “talking about” something. Polster and polster uses the term “aboutism” to describe narration without feeling or action.

“Gestalt therapy tries to restore the connection between aboutism and action. By integrating action into the person’s decision-making process, he is pried loose from the stultifying influence of his aboutist ruminations. (p.234)”

The client has a something to say. The therapist encourages the client to put this narrative into action. The above quote gives us also a sense of how gestalt therapy actually releases a person of a key symptom of depression and anxiety — rumination (Nolen-Hoeksema, 2000). Rumination is experienced as having obsessive circulating thoughts.

By encouraging the client to put talk into action, his/her ruminating thoughts gets translated into physical acts of doing.  These thoughts no longer get trapped in cognition. As the client acts out thoughts he/she experiences some control of these ruminations. The most likely thing to happen in the process is the out pouring of emotion.

Dialogue is Action

Dialogue is talk in action. Every psychotherapeutic dialogue has the potential of being curative, provided that it encourages the client to move away from the cognitive aspect of the talk — i.e. aboutism or talking about– towards acting and feeling the talk.

How can the gestalt therapist put talk further into action?

Through experimentation.

To be experimental is to constantly ask the questions, “what if…” or “what would happen if…” . What if you had the chance to say __ to your mother? What if your father were in this room now? What would happen if you tapped you hands quicker? … etc.

Each action is dealt with in the here-and-now. The follow-up questions would sound like, “what is happening now?”, “where are you at the moment?” “what comes to mind at this moment?”

The therapist is also part of the experiment. When the therapist is able to share his/her own experience at the moment, it can help the client better experience the phenomenon taking place.

Hycner (2009) aptly considers a gestalt therapy session a crucible, a small, self-contained space in which the client gets to experience new ways of being in the world.  A crucible is what is used in experimental chemistry.

 

Bibliography

Breuer, J., & Freud, S. (1893/2009). Studies on hysteria. Hachette UK.

Hycner, R. (2009). Relational Approaches in Gestalt Therapy. NY: Gestalt Press.

Polster, E., & Polster, M. (1974). Gestalt therapy integrated: Contours of theory and practice (Vol. 6). Vintage.

Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109, 504–511.

 

Levels of Gestalt Therapy Treatment Methods

A client who has just started therapy will experience different kind of session as a client who has been with the therapist for a longer period of time. Similarly, clients who experience psychosis would benefit from different style of therapy than clients who have issues based on neurosis. Then there are clients who seek therapy because they are facing really difficult existential issues in their lives. Their therapy would be experienced differently.

Gestalt therapy is known for its multi-variant techniques. However, what is seen as techniques is not Gestalt therapy. Gestalt therapy is the principles that lie under these techniques, within the dialogue between patient and therapists.

Different people, different needs at different times.

Level 1: Being present for the Client

The basis of all good therapy work is work with empathy, listening and validating. Being present, attentive, authentic and connecting with the client and inviting the client to be in contact. Contact work as such is healing, as it works towards reducing anxiety and loneliness that comes with it. Being present is really about the therapist putting aside prejudices, need to help, self-evaluation, analyzing the client or giving advise.  This is very important fundamental attitude for therapists in the session. It is also the most challenging.

This is also the only way to help clients who are psychologically very fragile and fragmented heal.

Irvin Yalom, in his biography, talks about one of his first clients, Sarah B., the wife of a business tycoon who suffered catatonic schizophrenia, who existed in a frozen state, not able to react to stimuli. Being a new in the profession, he was at a loss for what to do. He decided, during his rounds at the hospital ward, to converse with his non-reacting patient. He spent these 15 or so minutes talking to her about his day, the headlines etc. It was not till new neuroleptics came to existence did Sarah B. was able to move again. When she came around, the author mentioned to her of his multitude of doubts that he was of help to her in all those hours. She answered, “but Dr. Yalom, you were my bread and butter.”

Level 2: Phenomenology and Body Awareness

As the therapy progresses, and depending on the client, more work is done on the awareness of the body. This is not bodywork, but the momentarily focus on tension in the muscles and breathing. This is done in a dialogical way.

The more stable client would get sessions that looks like a play of being present. Looking at the phenomenon of the moment. What is going on, how the interaction feels like in the moment. What comes to mind now, etc. is discussed.

Level 3: Use of Creative Media

The use of creative medium, like art and music is useful at this stage for self reflection and sharing one’s internal structure with the therapist.

Further into the course of therapy, the client gets to work on relationships intra-psychic and external. Gestalt therapy is known for it’s two-chair work.

Level 4: Confrontation and Frustration

Very stable, self-sustaining clients who need therapy for self-awareness, who already have months or years of sessions with the therapist, may appreciate the challenge  that involves frustration of resistances, etc. This is done with all the first three levels intact. Gestalt therapy is never without level 1 !

What is being “frustrated” is the clients tendency to deprive him/herself of his/her need. For example, a client feels loneliness and longs to ask a lady for a date. He  is, however, so fearful of being rejected that he keeps to himself rather than calling her. The therapeutic frustration here is the confrontation of his fear of rejection.

At the end of the day, empathy is the most important aspect of therapy. 

Most therapy with clients do not reach the confrontative stage, and most sessions of gestalt therapy do not involve empty chair work. All clients at all stages of therapy are served best at the first level. It is also the most challenging part of the work.

Integrating Kernberg’s Model of Personality Organization with Gestalt Therapy

Kernberg’s model of personality organization provides us with a helpful visual of how differently experienced psychological symptoms relate with each other. Symptoms of personality disorder are very individual and unique each client. The “severity” of the symptom is phenomena “felt” by other people in the community and the therapist. It is therefore more accurate to base our assessment of the client’s problems on the effect the client’s behavior has on others and therapist, and based on how fixated the client is on this behavioral pattern. It is assumed that the more fixated one is on a mode of behavior, the less one is able to function socially and economically.

Kernberg established 3 main group of personality organization. These are arranged in increasing order of “severity”: 1. the Neurotic Personality Organization (NPO), 2. The Borderline Personality Organization (BPO), and 3. the Psychotic Personality Organization (PPO).

Horizontally, Kernberg also categorizes the symptoms as a spectrum of introvertion and extrovertion. This describes how much the individual with such diagnosis interacts with the other. The more introverted would keep the self in isolation. This would range from shyness to complete fear of being with others (as in severe paranoid PD / schizoid PD). The extrovert range would range from being dependent on the presence of others ( as with the dependent PD) to victimizing others (as in malignant narcissism PD or antisocial PD).

Most severe condition is the psychotic condition.

Kernberg (2008) Model of Personality Organization

When we connect this with Melanie Klien’s (Kernberg is a Kleinian) model, we can see that the BPO represents the condition where an individual is stuck at the paranoid-schizoid phase. The NPO represents the individuals who have developed into the depressive phase. *Note* that the terminology here is very confusing, because “paranoid-schizoid” and “depressive” used in this context has not much to do with the absolute meaning, but rather serves to describe a phase.  Please refer to this article for clarification on this topic.

When we consider Kernberg’s diagram, we may be able to appreciate how if the individual is fixed to the BPO, he/she may be holding on to maintain an intact sense of self. The consequence of not having the symptoms may lead to breakdown and possibly psychosis. As therapists, we must be very aware of this “ability” of the client to support him/herself in this way, even though his/her behavior is hurtful/harmful/not helping. 

The Contact Cycle in Gestalt Therapy

In Gestalt therapy we talk about contact. Contact is a means of a organism (a person) getting in touch with his/her needs and being able to get his/her needs fulfilled. This is not unlike Marslow’s concept of the hierarchy of needs. Needs not met will end up in the individual being weakened or even harmed as a result of accumulated stress. A very simple example: if a person’s body is lacking in nutrients, the person needs food. If he does not get this food, he suffers. Needs are always present. We have to be able to first realize the needs. In Gestalt therapy, the work of the therapist, for example, is to help the client uncover his needs of the moment, how he denies his needs by numbing himself from the sensation of the need, how he attributes the needs to someone else by projecting the needs and how he is not able to feel satisfied once the need is met.

Below is my sketch of the contact cycle in gestalt therapy. It is complicated, but there are simpler diagrams on the net or in books.

When the need is recognized, acted upon and assimilated, the gestalt is closed. The client is relieved of a stressful condition (that may have pervaded his life).

Shame at the Pre-contact Phase: When we look at the contact cycle, we can see that the hinderance to pre-contact is desensitization. The client does not know about this need. Oftentimes this is attributed to shame: when it is too shameful to even tell oneself that one has this need. Many people do not feel shame also for this reason. They anesthetize themselves from the sensation.

Anxiety at the Action Phase: The next part of the cycle is when one feels a need but acts inappropriately so as not to be able to fulfill the need. This is a miss-action normally caused by projecting what one feels or needs to others. For example when one is completely angry at another, he/she instead thinks that the other is hostile. Oftentimes the projection is brought about by anxiety or a dreaded fear of acting accordingly, but instead act by splitting this action from the self onto the environment.

Guilt at the Assimilation Phase: At the end of the phase, problems arise when the person is not able to assimilate what he/she has felt and done. This is probably the problem with overeating (this a simple example): the person is hungry, eats, but cannot feel nourished. In the realm of personality disorder, it is often the problem of the individual not being able to recognized his deeds, and avoids the feeling by not being able to feel a sensation of satisfaction (lustfulness). There would be continued hunger for whatever the need may be.  In serious cases (perhaps antisocial PD) if one has committed a crime, one is not able to sense guilt or remorse.

Gestalt Therapy and Kernberg’s Personality Model

In the figure below, I try to fit the 2 models together. This is of course, like all models and classifications, a way of conceptualizing, and not fixed truism. One would be well served to look at all graphical representation of psychic phenomena as as spectrum rather than as in discreet boxes and lines.

Personalities “stuck” in the avoidance of guilt end of the contact cycle, for example is caricaturized by the cold-blooded malignant narcissist or sociopath. When we look closely at all other personality fixations we can also see avoidance of guilt. Ultimately, this is all related to context.

Connecting these concepts can be useful to the gestalt therapists who use the contact cycle as means of understanding the mental processes of the client. It also helps us to access what difficult emotions underlie the personality structure of the client. Work with personality disorder is extremely complex because it deals with contact, not only with the environment, but also with the therapist’s personality.

I hope this idea is useful.

Bibliography

Kernberg, O. (2008). Aggressivity, Narcissism, and Self-Destructiveness in the Psychotherapeutic Rela: New Developments in the Psychopathology and Psychotherapy of Severe Personality Disorders. Yale University Press.