Tag: change in psychotherapy

Francesetti: Gestalt Therapy, an Engine of Change.

This lecture was given by Gianni Francesetti in Madrid on 22nd Sept 2023 at the European Association of Gestalt Therapy conference.

This article is a work in progress…. These are my notes and personal reflections on this lecture.

@ 10:30 On the topic of “Boring.“

Francesetti begins by explaining that he has tried to make his speech less “boring”. He then says, “Boring is not so bad, maybe.”

He will mention this phenomenon of boredom — which I find noteworthy due to personal experiences as someone who often gets bored myself and working with clients who feel chronic boredom as a practitioner — later on in this lecture.

Field perspectives in Gestalt therapy: there is a growing interest in the field perspectives in the current psychotherapy universe. This has much to do with current clinical issues. Frank Staemmler (2006) writes about the concept of ‘field’.

What does “Field” mean? Is it different for each person, or is the feel a “common” dimension?

@13:15 The speaker mentions that different people use the term “Field” differently, and even the same author may use different meanings of the word field, that a definition needs to be made. I tend to think that perhaps this is precisely what the term is about. The field is an all-encompassing concept, and all meanings of the word field are valid and useful to psychotherapeutic work.

@13:59 Is the field different for each person or is it a common dimension in a given situation?

The field as organism-environment contact/unity, and the key historical influencers to the concept of field theory in Gestalt psychotherapy.

@ 35:20 What are the clinical issues we are facing today?

Case study

Psychopathology, just like life, is a fractal.

References

Francesetti, G. (2023). Gestalt therapy. An engine of change. Lecture EAGT Conference on 22 Sept 2023. Madrid. retrieved from https://youtu.be/dSIGs2bbwGU?si=cQGEKwFSDBMZFTbo&t=506

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

The Psychotherapeutic Alliance and Change: A discussion on the healing aspects in a psychotherapeutic relationship

Abstract

This thesis addresses the complicated nature of the psychotherapeutic alliance, by attempting to deconstruct what is already in practice. In piecing out the different aspects of the relationship between psychotherapist and client, and referring back to relevant literature, one can understand better the dynamics that exist within the therapeutic encounter. In the process, one can also see how the different principles of different psychotherapy schools fit into what we understand today as the profession of psychotherapy. Considered a profession, psychotherapy is bound to ethics, within which is the question of competence and accountability. The importance of understanding what really happens in a client-therapist meeting that is unique to psychotherapy, and that which leads to therapeutic change, is emphasized in this paper, with case studies from classical texts and referred back to modern day change-process research.

Keywords: psychotherapeutic alliance, psychotherapeutic relationship, psychotherapeutic change, psychotherapeutic process, psychotherapeutic dialogue, I-Thou.

To download pdf, click here.

Helbig_2017_Bachelor_Thesis-nh-s-p

How a therapist can tell the progress of the patient

An essential aspect of the therapist’s work is tracking patient progress. In my practice, I look for signs at every session, even if I do not mention them to the patient.

The healing process in psychotherapy is often a subtle one. The therapist can easily overlook these changes, meeting the patient every week. Therefore, I give special attention to looking out for the signs.

Importance of looking out for the patient’s progress and change during therapy sessions

It is helpful for the therapist to be alert to change. Patients are typically oblivious to the subtle changes in their own personalities. Left on their own, individuals may start doubting their new sense of being (due to persistent introjects / resistances).

Noticing the client’s change and progress is helpful to them. The therapist bringing attention to the development of the patient helps the patient to integrate fully with this new attitude or behaviour through:

  • acknowledgement of the perceived change,
  •  Appreciation of how the change is impacting the life of the client,
  •  Understanding of how the change is developing and meaning-making,
  •  Assimilation of the experience, i.e. how it feels to exist with this change.

Some signs of change were observable in the patient during therapy.

There are many signs of change. Here is a brief description.

  • Change in how the patient makes eye contact makes facial expressions.
  •  Change in posture, dressing, hairstyle — not the usual styling change, but when the client comes in, their aura feels different.
  •  Change in topics brought up in session — most individuals bring up a focus topic (like work or kids…). I’d notice a difference when the subject is no longer interesting to talk about or when another becomes figural. Generally, when the topic becomes more about the experiences of the self, it is progress.
  •  Change in the client’s emotional vocabulary.
  •  Client’s own account of perceiving new feelings or losing anxiety. Especially after the holidays, the client reports that certain old feelings of anxiety around the festive season are no longer felt.
  •  The client making new decisions. This applies to clients who have difficulty doing so.
  •  The client who intends to reduce medication (especially meds that have been prescribed for a long time) reports having alleviated physical symptoms.
  •  The client who reports that children/spouse, etc, are “doing better” (usually relationship-wise).

Note that these changes may not mean that the goal of therapy is reached. Change indicates that the therapy is in progress, and the patient can look forward to more enrichment from the sessions.

Different Facets of Countertransference

Different feelings brought about by countertransference during a therapy session. Here is a rundown of how countertransference within a therapeutic relationship can manifest itself.

 

Transferences from therapist’s own childhood unfinished business is put onto the client. For example, the client reminds the therapist of his controlling mother.

Reactive feelings arising from therapist’s own narcissism.  Like defiance, being offended, wanting to take revenge, envy, lust, feeling insecure, feeling  inferior or superior, etc.

Complementary countertransference: when the therapist encounters the transference of the client, out of which incites the therapist to behave towards / feel towards the client the way the client’s  caregiver or significant other  would feel.

Identification with client’s significant other (parent, child, spouse, children, boss): in such a way that the therapist cannot empathize with the client.

Projective Identification: Feelings of the patient’s childhood experiences which have been split/dissociated, and projected onto the therapist and simultaneously the therapist feels and acts in a way (e.g. sadistic, critical, judgmental… like his father) that leaves the therapist bewildered.

The consequences unrealized countertransference feelings is that the client is robbed of the empathy he/she needs from the therapeutic sessions, which ultimately renders the therapy unprogressive.

The challenging job of the psychotherapist is to be constantly aware of these feelings and the sources of these transference. Self awareness through self therapy, and workshops and supervision are the only and best way to work through these transferences.

 

 

Notes: A Study Using Psychotherapy and fMRI Neuroimaging

A clinical case study of a psychoanalytic psychotherapy monitored with functional neuroimaging.

Tables and images in article

Reference

Buchheim, A., Labek, K., Walter, S., & Viviani, R. (2013). A clinical case study of a psychoanalytic psychotherapy monitored with functional neuroimaging. Frontiers in human neuroscience, 7.

Former patients’ conceptions of successful psychotherapy

This article features a study by Binder et. al 2009,  Why did I change when I went to therapy? A qualitative analysis of former patients’ conceptions of successful psychotherapy. 

The findings of this study provides us with some answers to what patients or clients of psychotherapy regard as change in psychotherapy, and how they perceive their experience in therapy which is considered successful for them.

The client’s point of view is very important. Mental states cannot be fully measured, as opposed to physical states. There is no machine, or test kit to measure the mental state of health. A person’s mental wellness is witnessed through his/her ability to function in daily life, and also his/her own perception of how things are.

What is successful psychotherapy or counseling? If a client claims to feel better, we’d ask what they meant. It could mean they feel more relaxed, less stress, less anxiety.  They could say that they are able to sleep better, have less physical pain. Or they could feel more energetic– whichever is important to the client at the time.

Methodology of this Study

The qualitative research was conducted using semi-structured, qualitative, in-depth interviews with 10 former psychotherapy patients, recruited through an advertisement in a local newspaper. A descriptive and hermeneutically modified phenomenological approach– i.e. using expert interviewing and not just questionnaires in order to grasp full meaning of what is transpired in conversation –was used to analyze interview transcripts.

Findings

What was most important explicitly for the clients in the therapy?

1  Having a relationship to a wise, warm and competent professional.

  • the client’s feeling of safety within the therapeutic relationship was mention.
  • the therapist having the right doses of contact with the client, and
  • the therapist having flexibility in approach to working with the client.

2  Having a relationship with continuity, safety and hope when feeling inner discontinuity.

  • the continuity, consistency of the therapy.
  • therapist being with them through difficult emotional experiences.

3  Having beliefs about oneself and one’s relational world corrected.

  • the patient is able through therapy to reconnect with his/her meaning making, having a look at misconceptions or introjects of which the client was not aware of.
  • therapists guides the client through his change of the worldview.

4  Creating new meaning and see new connections in life patterns.

  • the idea of having been helped by having one’s beliefs and belief systems corrected,
  • help in making new choices, or change in habitual patterns
  • helps the client see how the his/her present experiences and behavior in reaction to the experiences are rooted in the past experiences, i.e getting clarity and insight.

Comments

This study reflects what I see in practice. Good outcomes in psychotherapy happens when the client is able to engage in the sessions with support of the therapist. The route to good outcome varies with individuals and the therapeutic alliance.

Bibiliography

Binder, P. E., Holgersen, H., & Nielsen, G. H. (2009). Why did I change when I went to therapy? A qualitative analysis of former patients’ conceptions of successful psychotherapy. Counselling and Psychotherapy Research, 9(4), 250-256.