How do we explain the transformative work of psychotherapy? The therapist and client of the psychotherapeutic encounter do not exist in an isolated bubble; both exist integrated with the environment we call the field. The field encompasses the biological, psychological, physical and sociological environment in which the therapist and client are embedded. The psychotherapy situation is in constant flux with the field. Psychotherapy is an open system.
Change in psychotherapy is complex, non-linear, and perceived as organic. The psychotherapy profession has long understood this concept, which differs from the paradigm of the broader field of the medical model of healing that views the patient as a unique entity disconnected from the environment.
The medical model approach considers the patient and their issues unique to the individual, often ignoring the environmental contribution to the patient’s suffering. The patient sees the medical professional and gets treated for their symptoms. Usually, the patient is offered medication to relieve symptoms, and healing is expected to happen spontaneously. Sometimes healing does not occur, but just an alleviation of suffering. Diagnosing and treating the patient this way is the mono-personal approach to therapy.
The figure below illustrates the different dimensions ‘ways of seeing’ psychopathology (suffering and symptoms), treatment and diagnosis in therapy. The relational attitude is adopted by contemporary psychotherapeutic schools, where the study, focus and treatment is experienced in the therapeutic relationship.
The field theory is unique to Gestalt therapy. Contemporary Gestalt therapists have attuned themselves to investigating psychopathology and therapy even further by looking at the aesthetics of the co-created field.
A Gestalt therapy perspective of psychopathology is necessarily grounded in a field epistemology. The field concept enables us to understand experiential phenomena as being emergent from a dimension that cannot be reduced to the individual, or to the sum of individuals at play. Every relational situation actualises a new, original field. Subjective experience is not the product of a single mind or isolated individual; it is an emergent phenomenon of the actualised field.Francesetti, 2015
The co-created field encompasses the client and therapist in their bio-psycho-social environment and is unique to the encounter. Read also: Notes on Field Theory in Gestalt Therapy. Field theory renders the therapeutic encounter an open system. Neither is the client treated as an individual nor is the therapeutic situation treated as separate from the outside world. The field theory includes everything relevant to the here-and-now of the therapeutic session. Attunement to the field involves noticing and focusing on the atmosphere of the therapeutic situation. Change is effected through the field. Movement in the field facilitates meaningful psychotherapeutic change and transformation.
As we consider the concept of the co-created field in psychotherapy, we will also realize that psychotherapy is an open, dynamic and complex system.
General systems theory
General Systems theory is an interdisciplinary practice applied to many fields of sciences, including cybernetics and biology. The concept was published in 1934 by Austrian biologist Karl Ludwig von Bertalanffy (1901-1972), who proposed that the classical law of thermodynamics, which applies to closed systems, has limited relevance to open systems (Wikipedia, 2020).
The phenomenon of Synchronization
The videos below demonstrate the phenomenon of synchronization. Unique objects with their own stable pattern, influence the co-created environment, causing their own patterns to change.
This is another example with the use of several metronomes, each with their own temporal settings. After a while, all metronomes sync together.
Synchronization happens in biological systems. All biological systems are attracted to the field which guides their growth and movement.
Psychotherapy and General / Dynamic Systems Theory
Psychotherapy is an open complex system, like all biological systems and groups. Open complex systems are self organizing, and creatively adjust to their environment. They dynamically change with time. This change is continuous and non-linear.
Open systems oscillate dynamically and try to find stability. Transformative change involves the process of deconstruction, reorganization and reconstruction. In psychotherapy, pathos or suffering is sensed, grasped, and brought to the surface. The client learns to frustrate old patterns by attempting behaviour change and meeting the therapist at the contact boundary. This process can happen through experimentation and (sometimes accidental) confrontation of transferences.
The client’s “pathological” situation is an autonomous pattern formation, which the client would like to change. This pattern is, however, a stable pattern that has developed through life experiences and trauma. It is a meaningful pattern, though often dysfunctional that the individual has adapted to since childhood. In psychopathology, some patterns have more severe consequences for the person, like obsessions and compulsions, and anxiety. In less severe states, the individual suffers setbacks in relationships due to personality and unstable attachment styles. This pattern is played out in therapy and felt in the field. The attuned therapist can grasp how the therapy situation impacts them in the co-created field with the client.
In therapy, the client’s pattern is challenged. The challenge brings about resistance. We can say that the old pattern repels this challenge. The client may get used to this challenge and change. This may manifest as the ability for the client to attend therapy as a routine. This initial influence of therapy on the client is the first -order change. Here lies a comfortable synchronization in the field.
Transformation happens at the second-order change. This process takes time. The second-order change is the lasting permanent change of the pathological pattern. Second-order change requires the deep modification of the system’s way of functioning. In Gestalt therapy, this is a phase of change called the impasse. Read also: Gestalt Theory: 5 Phases of Therapeutic Change. When the client can stay in therapy long enough to find themselves in a situation of the impasse, which is often an uncomfortable state, a transformation phenomenon happens. At this stage, there is a re-synchronization, and the new pattern becomes stable. The client experiences a shift.
In trauma therapy, the synchronization that happens in the therapeutic encounter is also a physiological one. The therapist provides the client with a safe space and a centred presence in the therapeutic field. The client who shares the field, like the opposing metronome in the videos above, begins to operate in sync with the therapist.
Therapeutic change and transformation works through synchronization, and this involves the passage of time. Psychotherapy is a powerful resource that offers deep organic change and psychotherapeutic treatment. Shortcuts and quick fixes has never been the premise of psychotherapy.
On the lighter side…
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Francesetti, G. (2015). From individual symptoms to psychopathological fields. Towards a field perspective on clinical human suffering. British Gestalt Journal, 24(1), 5-19.
Ludwig von Bertalanffy. (2022, November 20). In Wikipedia. https://en.wikipedia.org/wiki/Ludwig_von_Bertalanffy