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.

What do Gestalt Therapists do?

Gestalt therapy is an effective an efficacious form of psychotherapy (Roubal, 2016). Gestalt psychotherapy is practiced by certified psychotherapists trained and supervised in the modality. Anyone who is interested in having gestalt therapy as a treatment for psychological and psycho-somatic stress or pain, or for the treatment of systemic issues regarding relationships in families or organizations, should seek a gestalt therapist who is actually trained and licensed as one.

Gestalt therapy is often described as a humanistic and holistic form of therapy. What this means, is that when a client comes to a gestalt therapist, he/she can expect to be met with a trained person who has been treated with gestalt therapy him/herself.  Here I emphasize the person as an instrument of treatment, as opposed to other instruments like medication, techniques, advise or exercises.

Established gestalt therapists have identified observable behaviors  that one can expect of gestalt therapists at work. This is documented within the gestalt therapy fidelity scale, or GTFS (Fogarty et al., 2016).

So, what do Gestalt therapists really do in the session? 

 

Developing awareness.  It is said that “knowledge is power”.  Awareness, however, takes the client way beyond empowerment. It leads towards self-agency and healing. When a client approaches therapy, he/she is really looking for healing answers. This knowledge is given to the client through newly acquired self-awareness. Gestalt therapy acknowledges awareness as encompassing 1) inner emotions feelings, 2) behavior, speech and actions, and 3) thoughts, judgements,  beliefs.  Developing awareness is not what the therapist does per se. Its intent is, however, central to the work.

Working relationally.   Clients usually come for therapy with a target complaint. This complaint is very valid to the goal of the therapy. It is not unlike going to the doctor with a health complaint. Gestalt therapists, however, handle the complaint differently from doctors.  The therapist pays attention to the client’s interaction with the therapist in the session and the therapist pays attention to his/her own resonance with the client in the session. The therapist has no pre-determined agenda. For example, a client comes in with complaints of insomnia.  The therapist focusses on the client interaction with the therapist in the session. There is no judgement on part of the therapist. She allows the client to freely express himself. She pays attention to the differences between them. She notices how the client talks quickly with flat affect. She notices also how she feels “heavy in the head” as the client speaks. Giving attention to this dialogical interaction, the therapist and client gain awareness of the client’s mode of being in the world. The client learns of the psychological burdens that keeps him up at night.

Working in the here and now. The therapist asks the client about his immediate experience. If the client mentions a disappointing day at work, the therapist would notice his facial expressions and tone of voice as he recounts his experiences.

Phenomenological practice. The therapist would bring these feelings to awareness of the present moment, thereby helping the client to describe and deepen his sense of theses experiences and gain better understanding of the presenting issue.

Working with embodied awareness. The client is encouraged to observe his emotions and bodily sensations.  The therapist may notice the client’s shallow breathing, for example, and mention it.  Through this deep embodied understanding the client is encouraged to try new movements. He realizes that he has choices. 

Observance of the resonance in the relationship. The therapist is sensitive to the context in which the dialogue takes shape. Themes emerge. Emotions emerge. The therapist shares with the client her experience of what emerges. The client is empowered, with this awareness which is otherwise unconscious to him.  He is provided with the new learning of his role in his past, present and future relationships.

Working with client’s mode of relating. The therapist acknowledges the client’s relationship pattern as these emerge during the session. In gestalt therapy, both therapist and client co-create the space in which they reside. They explore how they impact each other in the relationship.

Adopting a spirit of experimentation. Like in a kaleidoscope, small changes in movements lead to complete change in form of the pattern. The therapy session is like a crucible of life. The client is encouraged to experiment with new ways of being: simple moves within a session like a movement of the hand or uttering a sentence to somebody on an empty chair. The therapist supports the client with these experiments. They explore ways in which he can integrate these experiences in the world outside the therapy session.

The client leaves therapy with new awareness and is armed with choice. In the case of the client who has had insomnia, work with a therapist in the gestalt modality can be effective. The client works on his self as a whole, rather than only with his sleeping problems. The client is not his illness. He is a person who has feelings and relationships. Working on his self-awareness, the client gains agency over himself. In therapy, he experiments with ways of being. He finds answers to questions that affect his life. He gains better understanding of his past, present and future. He gains self-compassion. He learns to let his body rest at night.

Bibliography

Fogarty, M., Bhar, S., Theiler, S., & O’Shea, L. (2016). What do Gestalt therapists do in the clinic? The expert consensus. British Gestalt Journal25(1), 32-41.

Roubal, J. (Ed.). (2016). Towards a research tradition in Gestalt therapy. Cambridge Scholars Publishing.

Contact for gestalt therapy in Singapore or recommendations internationally

Analyzing a Gestalt Psychotherapy Session Using the Helbig Method of Dialogue Analysis (HELDA)

Abstract

How can we visualize the evolving psychotherapeutic alliance in dialogue? The psychotherapeutic dialogue is an important source of data for psychotherapy outcome and process research. Micro-analyses of dialogical turns within the therapeutic session support the understanding of the therapeutic method. This paper introduces the Helbig Method of Dialogue Analysis. This method is founded upon 4 pillars: 1) that dialogue is implicit action between persons that is supported by explicit verbally uttered content, 2) that the individual’s mode of inter-action within the dialogical dyad reflects the person’s relationship theme or pattern which plays out in the here-and-now, 3) that dialogue is an intersubjective process that leads to the development of new intersubjective configurations, and 4) that the observer-researcher’s phenomenological involvement plays a part in the analytical process. In this study, a 28-minute video-recorded gestalt therapy session is selected. The transcription of the session is coded using the instrument, the Core Conflictual Relationship Theme Leipzig/Ulm. Results obtained from this study are quantified graphical representations of the developing relationship between therapist and client. Simple to operate, scalable and practical, this method is designed for use by therapists and researchers who are interested in tracking, comparing and/or contrasting the developing psychotherapeutic alliance in a single or in multiple psychotherapy sessions.

Keywords: psychotherapy research, dialogue analysis, psychotherapeutic alliance, Core Conflictual Relationship Theme, gestalt therapy.

Download pdf. here.

NICOLE-HELBIG-PRINTING-copy

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. 

What does “healing” mean in Psychotherapy?

My work in psychotherapy is about healing through the integration of psyche and body. It is in my foreground every minute I work with a patient. Oftentimes it is not obvious that in our therapeutic conversation, there is an underlying therapeutic process.  The phenomenon of a relational gestalt therapy  (my school of study) dialogue is mostly felt, tasted and sensed, before it gets intellectually understood.

Subtle is the therapeutic process not?

When we go for therapy, we may experience change from the beginning, or no big change for weeks or months. We may talk about the same things in circles before something happens: an insight, an understanding, a gush of emotions, a relief from tension.  When and how we get to this point in the therapy is usually not foreseeable. The process can be described as to be like titration. We make small steps. There is no explosion, but natural, holistic change.

Case Studies of healing process in psychotherapy

Case 1, Mary: I recount a case study of a journalist named Mary (not her real name), who came to therapy because of stress due to conflict with her colleagues. Her goal of therapy was to reduce the stress and panic feelings when she is at work. She feared that she may become too emotionally unstable to go to work because of this. For months, Mary talked about her work environment, the colleagues and tried to understand the incidents that triggered in her deep emotions. She also talked about her work, which she calls “her passion”; to remind women of their rights through feminist writings and stories. More weeks went by, and I began to wonder myself if her process was heading anywhere. I stuck to the process of her work, which with time, saw Mary more comfortable with expressing more difficult emotions, especially feelings of vulnerability. Baby steps. One day, she revealed that she had been sexually assaulted by a group of college mates and that she had kept this incident a secret for 20 years. She was able, after 14 months of therapy, to talk about it in session.  Along with this revelation came a flood of feelings: resentment, shame, guilt, vulnerability, frustration, anger, grief, and also thankfulness. At one point, she was even angry at me for having initiated her emotional unravelling. For a couple of weeks, she said that she could not work. She then emerged from this. Mary transformed. She had been afraid of coming to terms with a painful past. In so doing, she re-lived her inner feelings of resentment, frustration and anger towards others and herself in her workplace and even in her writings. While these feelings helped her to write powerful articles, it also caused her to build walls between herself and the society in which she is in contact with. The conflicts left her stressed out and panicky at work. She was helpless against the emotional turmoil. Working through her traumatic experience, she unleashed the source of these painful feelings.  Through this process, Mary was awarded choice. She could tap on these feelings as motivation to write and guide others. She is, however, not bounded to these feelings anymore. She finds inner-calm — which she said “had always been there”, but she did not realize it– in her social context. With time, she was able to build more allies.  Panic feelings were soon of the past. Mary’s healing came about in little steps.

Case 2, Sunil: Sunil (not his real name), was a foreign student from India. He has chronic pain and problems with his digestive system, which doctors have diagnosed as Irritable Bowel Syndrome. He knows that his physical symptoms are related to “stress”(actually compulsive intrusive thoughts and actions) and sleeplessness. Sunil grew up experiencing family violence. With therapy, Sunil learned to notice his emotions and how past memories of childhood affects him today. He learned to observe the triggers in his everyday environment. He learned how to notice and accept his triggered self. Sunil learned to engage the support of his loved ones by explaining to them what was going on in him, and what he needed. With time and help from others, Sunil’s episodes reduced in duration and intensity. Sunil learned in therapy to be conscious of changes in his body when he got triggered. He was guided to find out what his body needed to calm down from its hyper-aroused state. Sunil’s healing process involved dealing with somatic reactions to triggers, and working through past hurts. Within months, Sunil’s digestive system stabilized. He also slept better. Sunil’s healing process was a holistic one.

So what is healing to me in the psychotherapeutic sense?

Mary and Sunil’s healing was a journey towards self-awareness and growth. The time, energy (and, not to forget, money)  spent in therapy rewarded them with freedom from unconsciously re-living traumatic pasts.

Healing in psychotherapy takes place when the patient is able to grow and transform through insight and experiencing (and sharing) of feelings. This healing provides the individual with choice. This concept of healing is unlike that of conventional thought of “healing diseases”, which strive to remove the disease. In psychotherapy, mental and emotional issues are not to be judged as bad and removed; but understood. Depression, anxiety, PTSD and personality disorders aren’t “diseases to be cured”. These are opportunities for personal growth.

The healing –in a way described in this article– achieved in psychotherapy, is permanent. What Mary has gained will be with her for life, and she will continue to grow with it.

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.

Dreams and Dreamwork in Psychotherapy     

The publication On Dreams was written by Freud (1900) after having written his (what was labeled) “book of the century”, Interpretation of Dreams. With these writings,  Freud tries to make his innovative ideas of dream analysis accessible to the wider audience. His was the aim of reaching the “educated and curious minded reader” (Quinodoz, 2013).

Freud prides himself in taking the mystique out of dreams. He says dreams are composed of latent and manifest content. The manifest content, Freud explains, is material that appears in a dream. The latent content is the material that underlie the dream that is hidden within the unconscious. Using his own dreams he analyzed himself on paper. With that Freud brings us on a journey towards his own dream work.

Freud and Adler’s Differences


Alfred Adler’s work on dreams is an elaboration of Freud’s.  While here is fundamental agreement of both theories, the main difference is that Adler is very much focused on the individual’s awareness of one’s position in society, and expression of one’s “style of life”, viewing dreams as having a forward-looking, problem solving function. Adler also realizes that the conscious and unconscious are not contradictions to each other, but a unity (Ansbacher & Ansbacher, 1956).

Adler made a point about dream analysis that transcended Freud’s: by acknowledging that even made-up dreams are significant to analysis (p. 359). It implies that the act of talking about dreams alone is fundamentally relevant to the therapy—no matter from where the dream arises. The use of dreams in psychotherapy functions in a manner to facilitate therapeutic process, help patients gain insight and self-awareness, provide clinically relevant and valuable information to therapists and provide a measure of therapeutic change (Eudell-Simmons & Hilsenroth, 2005).

Gestalt Therapy Attitude towards Dream Work in Therapy

How the analysand describes his/her dream is rich in not only the latent content of the dream, but also the latent content of the moment of analysis. Gestalt therapists work on dreams by acknowledging the phenomenon within the client at the moment of analysis.

Enright (1980) recounts a dream work done by Fritz Perls in Los Angeles 1963 (found in the section Memory Gems). After the client recounts his dream, Perls would ask the client to identify himself with elements of that dream, by talking about it in the first person. In an example, an elderly, subdued man had a dream of seeing some friends off on a train. The man worked at first by identifying himself as himself, then as his friends with no effect. As the man identified himself with the train, he felt a bit more energy. Perls then asked the man to “become the station itself”. Enright writes, “At first it seemed as unproductive as the rest. Then, as he said, ‘I’m old-fashioned and a little out of date—I’m not very well cared-for; they’re letting dust and litter accumulate—and people just come and go, use me for what they want, but don’t really notice me,’ he began to cry, and for the next few minutes the current and recent past thrust of his entire life became obvious—what was happening, what he was doing that wasn’t working, and even some possible new things to do.”

Perls, in this example, demonstrates a way of working in the moment. While working with a dream, client and therapist remain in dialogical contact. Nobody gets lost in analysis. The therapist deals with the process of the dream work rather than the content of the dream. Working with process allows a lot of creative freedom; the dream is treated like a work of art, “fruit of the extraordinary creative powers of childhood” from which the patient must be able to experience freely, free of theoretical considerations; so that the person can communicate with and re-create his/herself  (Sichera, 2003. p. 95).

Conclusion

Dreams are useful material for use in understanding the self. If the client brings a dream to the session, and if the dream has significant emotionality attached to it, it is worth spending time on. Recurring dreams are especially interesting, according to Fritz Perls.

The time and setting is also considered before such work is done. There are moments when working on particular dreams lead somewhere important. There are moments when dream work is not appropriate, or when the dream topic is a distraction from current material that is more important for the client.

Working with dreams are tools, but are not ends to itself. The focus lies always on the here-and-now.

Read also:

Dream Analysis

Fritz Perls: Working with Dreams in Gestalt Therapy

Bibliography

Ansbacher, H. L., & Ansbacher, R. R. (1956). The individual psychology of Alfred Adler.

Enright, J. B. (1980). Enlightening gestalt: Waking up from the nightmare. Pro Telos.

Eudell-Simmons, E.M. & Hilsenroth, M. J. (2005). A review of empirical research supporting four conceptual uses of dreams in psychotherapy. Clinical psychology and psychotherapy. 12, 255-269. John Wiley & Sons.

Freud, S. (1900). On dreams, Standard Edition of the Complete Psychological Works of Sigmund Freud. Vol.5. pp. 633-686.

Quinodoz, J. M. (2013). Reading Freud: a chronological exploration of Freud’s writings. Routledge.

Sichera, A. (2003). Therapy as an aesthetic issue: creativity, dreams, and art in Gestalt Therapy. In M. Spagnuolo Lobb & N. Armendt-Lyon (Eds.). Creative License: The art of Gestalt Therapy. NY: Springer.

 

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.

 

Making Contact with Culture: A Psychotherapist’s View

Kubik’s (2014) paper, Culture Contact: cognitive and psychodynamic aspects deals with interesting facets of the discourse of the concept of culture, that one would tend to overlook. It starts off simply, describing a scenario of two individuals holding passports from different continents. How do these persons view each other’s culture? How do they communicate their differences in culture? How much of the culture that represents each person’s heritage do each individual actually possess? How much do these individuals have in common?

Culture is learned.

In gestalt therapy terms, the learning is actually introjected (Clarkson, 2014, S. 58). Introjection is often also described as the act of swallowing information and influences without chewing it first. The difference between learning and introjection, is that learning is cognitive and introjection goes deeper— introjected material becomes the self. The resultant terminology is aptly called the cultural identity. Once it becomes integrated into the self, the self does not notice it any longer as material that is merely learnt. This could be a way of explaining why we tend to be blind to our cultural learnings.

The process of introjecting learned material in the cultural context can be described as enculturation.  Enculturation is a life-long process of introjections. This process serves the purpose of enabling the individual to integrate and function in the social sphere.

Society provides as much security as it traps the individual. This is how we also understand the concept of introjection – what we learn in this way is difficult to escape from if it doesn’t serve us positively. Hence throughout phases of life, we find ourselves having to deal with our cultural biases and adapting to other people’s culture.

The self as many voices.

I like to think of a learning of cultural elements as a way of obtain a new “voice” in our heads. Each introject is like introducing a new character or “face” (Satir, 1978/2009) in an intra-psychic theatre. As a child develops into adult these form the polyphonic voices similar to the ones we encounter in Dostojevskij’s novels (Bakhtin, 1984).  As the article mentions, these become our unique cultural profiles, which change dynamically with the influences we encounter in our lives.

Cognitive and Psychodynamic Levels of Learning

Learning involves being in contact with material. I guess that this is what the article alludes to with the term, cognitive level. We perceive and learn the material, but for the material to be internalized, it trickles thorough the psychodynamic aspects of our consciousness, the psychodynamic level.  What I am imagining is, that the perception of the learned material can be shared by separate individuals at the cognitive level, but each person makes meaning and introjects this material differently at the psychodynamic level.

An example is the symbolism of crows in Japanese culture as mentioned in the article, citing Akira Kurosawa’s (1990) film. Most persons at the cognitive level see the same crows— which are black birds— but the meaning different cultures make of crows are different. The Japanese culture, for example, sees the crows to be more injurious than perhaps other cultures. There are also explanations for it: the crows in Japan are bigger and more likely to attack people and property. Incidentally, in western media, the Raven, also a black bird is often depicted as a messenger of menace in literature—like in Edgar Allen Poe’s The Raven— and Hollywood films.

How Cultural Objects are Dealt with in Gestalt Therapy

Throughout my gestalt therapy training, we are constantly trained to be aware of the fact that we, as individuals, put different attributes onto tangible and intangible objects. These are also sometimes termed as cultural objects (Owen, 2015).  As gestalt therapist, we need to ask the client what the objects mean to them individually, so as to avoid assuming that we share the same meaning of the said object with our clients.

The content of the article is very relevant to our work as therapists. If we are able to be aware of our cultural biases, we will be better able to make contact with the client in therapy, thereby being more effective in understanding the client and his/her psychological issues.

Bibliography

Bakhtin, M. (1984). Problems of Dostojevskij’s poetics: Theory and history of literature. (Bd. 8). Manchester, UK: Manchester University Press.

Clarkson, P. (2014). Gestalt Counselling in Action (4th Kindle Ausg.). London: SAGE Publications.

Kubik, G. (2014). Culture Contact: Cognitive and psychodynamic aspects. Lecture at the University of Rome Tor Vergata Feb 25 2014.

Kurosawa, A. (Produzent). (1990). Dreams. [Kinofilm].

Owen, I. R. (2015). Phenomenology in Action in Psychotherapy.

Satir, V. (1978/2009). Your many faces: The first step to being loved. (Kindle Ausg.). Celestial Arts.

Fruehauf: Wang Fengyi’s Emotional Healing in Traditional Chinese Medicine

“All disease comes from the heart” writes Freuhauf (2006). With this statement, he refers to a traditional Chinese concept of illness.

The Five Element Theory of Chinese Medicine

Chinese medicine evolved in relative isolation, with little outside interference, and has held its own through time. Documents of Chinese medical writings date back to 1500 BC. Chinese medicine is based primarily on the theory of the five elements or wuxing (五行) and the concept of yin-yang (balance) and the idea of correspondence between organism (microcosm) and its environment (macrocosm). It is dependent on the natural rather than the supernatural. Hence there is belief in the connection between the body and nature. Human emotions are considered the “vital air” in the body, and are viewed as equivalent to nature, and that, which in turn connects the body with nature. The organs are considered to affect emotions (Tseng, 1973).

 

The wuxing is used to describe almost everything that is tangible and intangible in the universe. In the above diagram, the elements are represented by organs. Emotions are also allocated elements.  We can see from the table below how the wuxing is used as metaphor to explain the flow of relationships between objects and concepts.

Source: Fruehauf 2006

Wang Fengyi uses this principle as a guide to connect the illness affecting particular organs with emotions and relationships, etc.

Psychopathology and Chinese Medicine

The Chinese character for madness, feng 疯, is etymologically composed of two parts: wind 风 and illness 病. This indicates that such illness is brought about by extraordinary “wind”, a word which also implies emotions.

It is no accident that the modern Chinese term for psychosomatic medicine is xingshen bingxue, literally the science of how (primary) physical form and (secondary) spirit relate in the disease forming process. (Freuhauf 2006)

Since traditional Chinese medicine is characterized by the concept of visceral organs, patients frequently describe their psychiatric problems in terms of organs, like “exercised heart,” meaning apprehension, “injured heart” to mean sadness, and “elevated liver fire” to mean agitation and tension (Tseng, 1973).

Psychological problems are therefore deemed somatic- and organ-based, the Chinese never separated psychiatric disorders from other medical illness. Mental illness was never of particular pre-occupation in Chinese culture as it is in the west. Large mental asylums therefore have never been known to exist in pre-modern China (Ng, 1997).

Wang Fengyi’s Emotional Storytelling as Treatment for Somatic and Relationship Problems

When Wang Fengyi passed on in 1937, he left behind followers of his technique; one of whom is featured in the video above. The method of treatment is story telling. The practitioner sits among a group of people and tells a story (or something like a story). His story induces emotions in the individuals. From the video, we can see how the group dynamic plays an important part in the field. Even as a observer, emotions are induced in us. People laugh and cry at the same time. Some even throw up.

The explanation is that locked-up painful feelings (the practitioner in the video terms it poisonous feelings) are the cause of disease.  These poisonous feelings (hate, blame, anger, judgement and annoyance are described here) arise from relationships with others because there are things that we feel but aren’t allowed to come to terms with or say.

The negative emotions are part of the wuxing (five-element cycle) and blockage to this flow causes a blockage to the organs that are also part of the wuxing.

Releasing these negative emotions, free up the flow, and hence improves overall well-being of the person. In the video, we can see the cathartic effect at the end of the session.

Emotional Story-Telling and Gestalt Psychotherapy

Wang Fengyi’s concept of releasing painful emotions is concordant with the gestalt therapy. We do not call the emotions poisonous, but the emotions that we encourage to be expressed in the therapy sessions are nonetheless painful.

In gestalt therapy, therapists do not need to tell the stories. The stories come from the client. The therapist’s job is to support the client with the feelings that emerge from his/her narratives. Using the two chair technique, and “acting out” works in this way.

Gestalt therapy is also focussed on the somatic aspect of emotions. Very often we ask clients to locate the feelings in their bodies. Checking with the feelings in the body, brings the client to the awareness of the mind-body oneness.

The work of Wang Fengyi is very much relevant to me as a therapist. I gain much inspiration from this traditional wisdom.

 

Bibliography

Fruehauf, H. (2006). All disease comes from the heart: The pivotal role of the emotions in Classical Chinese Medicine. na.

Ng, C. H. (1997). The stigma of mental illness in Asian cultures. Australian and New Zealand Journal of Psychiatry, 31(3), 382-390.

Tseng, W. S. (1973). The development of psychiatric concepts in traditional medicine. Archives of General Psychiatry. 29:569-575.