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 who present phenomenon 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 is that of being in-efficient in doing daily tasks, since the preoccupation is on distracting details, rules and schedules, that leaves the main task undone. The quest for having tasks done perfect also leaves task unfinished. While everything takes longer to complete, there is obsession with work and productivity, leaving little energy left for leisure activities and relationships. Relationships suffer because there is a tendency to be overconscientious, and inflexible about matters of ethics. Many individuals with OCPD tend to have religious or ideological stance, that they hold on to. They may also have a fixed idea of how things should be done, and would not delegate their work to others, unless the others follow his/her way of executing the tasks.  Some persons show tendency to hold on to unnecessary objects.  Similarly there is a tendency to being miserly. A certain feature of this personality style is the display of rigidity and stubbornness. 

OCPD is differentiated from Obsessive Compulsive Disorder (OCD) by the by the presence of true obsessions and compulsions in OCD.

Obsessive Compulsive Personality Disorder Explained with Gestalt Therapy 

Looking at this condition through gestalt therapy lens, we can appreciate the complexity of the 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 against 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, and behaves so as to avoid the possibility of situations that leads to helplessness. This means 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. There need would be to not let go of the habitual thoughts and action, to see them as 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, 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. It is in my foreground every minute I work with a patient. Oftentimes patients do not realize that in our therapeutic conversation, there is an underlying therapeutic process. This is because the therapeutic dialogue is, a conversation with another person, but different.  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 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.

Case Study of healing process in psychotherapy

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, however, recovered 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 of 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 past.

So what is healing to me in the psychotherapeutic sense?

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

Healing in psychotherapy takes place when the patient, like Mary, 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.

 

 

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.

Your Inner Child in Children’s Stories

I am deriving the inspiration to write this article from Claudio Naranjo’s The Divine Child and the Hero: Inner Meaning in Children’s Literature, and a presentation I have to give to the class on the topic :Work with the inner child in Gestalt therapy.

It is often said, that there is a child in every adult. Some individuals are better able to recognize this child than others. If this inner child were to exist, it lives in the intra-psychic world of the adult person. Being a child, it is vulnerable.  Being vulnerable, the inner child is often the one that feels the fears (in panic attacks, perhaps?), feelings of abandonment, the rage in depression, the loneliness of existence… In gestalt therapy, this inner child is sometimes synonymous with the “under-dog”.

Existing with the “under-dog” is, of course the “top-dog”.  The “top-dog” is the grown-up person’s psyche. This is made up of the introjected voices of a person’s mother and father.  It is also sometimes referred to as the super-ego.  The super-ego protects the individual as he/she grows into an adult. The top-dog steers the person to achieve all the things he/she want’s in life (e.g. sense of self worth, protection, etc.).

In our strife to get the most of life, to be more autonomous and less vulnerable, the inner child gets sidelined. This “under-dog” suffers in secret. This suffering often goes unnoticed. The suffering sometimes also manifests itself as psychological or physical (a.k.a psychosomatic) distress.

What is the inner child about, really?

I hope you enjoy this short presentation:

There are many types of children’s stories. Naranjo (1999) shows us how these stories can be categorized into 2 broad groups: The matriarchal- and patriarchal-type stories.

The stories he cites as patriarchal are:

The lion, the witch and the wardrobe, by C.S. Lewis; The Hobbit, by J.J. Tolkien; The book of three, by Lloyd Alexander; and The Sword and the Stone by T.E. White.

Others I can think of are: princess stories, stories of overcoming good and bad…

The stories cited as matriarchal are:

The little Prince, by Antoine de Saint Exupéry; Tistou of the green thumbs by Marcel Druon; The Animal family, by Randall Jarrell and Charlotte’S Web by E.B. White.

Others include: Alice in wonderland, Life of Pi, Dr. Seuss.

How are these groups different?

    

Conclusion

Stories change us. Time changes us. We develop. We develop to be adults, while our inner child remains the innocent “divine” child. Children stories tell us much about ourselves. We are not one or the other, we are both. We are both top-dog and under-dog. We live with our internalized matriarch (mother) and our internalized patriarch (father). These adult voices help us to grow up and gain autonomy. The inner child, however, remains always curious and trusting.

Bibliography

Naranjo, C. (1999). The divine child and the hero: Inner meaning in children’s literature. Gateways/IDHHB Publishers.

Me with Claudio in 2015. Is an unforgettable time.

Levels of Gestalt Therapy Treatment Methods

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

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

Different people, different needs at different times.

Level 1: Being present for the Client

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

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

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

Level 2: Phenomenology and Body Awareness

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

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

Level 3: Use of Creative Media

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

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

Level 4: Confrontation and Frustration

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

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

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

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

Humiliation, Shame and Violence

This is a presentation I gave some years ago on the connection on antisocial violent behavior in some men, and how researchers (in this article I feature the work of J. Gilligan) have learnt how these violent behaviors are linked to culturally-adapted values. Such values function as introjects in individuals. The resultant of which is violent and aggressive emotions as consequence of displaced feelings of humiliation and avoidance of shame.

Mass shooting incidents do happen and the perpetrators leave behind chilling messages that point to a root cause, which Gilligan has pointed out.

 

Here are the list of extreme cases of violence in young males. The motives for their actions were later revealed to have mysogynic undertones. Many express their hatred for women.

Working with Shame

  • Empathic understanding of the patient’s experience with shame
  • Assist the client to understand fully this experience.
  • Showing warm understanding, acceptance and respect.
  • To heal shame, the therapist must understand shame. Therapist must understand this in context of the patient.
  • Therapist must be committed to dialogue.

(Yontef, 1996)

  • Hold the client in unconditional positive regard.

Working with Humiliation

Why Humiliation?

Shame is related to humiliation, but they are not the same emotions.

The Phenomenological difference between Shame and Humiliation

  • Humiliation relates to distinct “self and other” interactions, and to distinct levels of self-definition.
  • Humiliation is done by one person to another purely for own selfish purpose.
  • Humiliation implies an activity occuring between oneself and another person.
  • “Humiliated” is a feeling of position of oneself in relation to another or others. It is also an interpersonal interaction.
  • Humiliation is the feeling of an act of being put into a powerless, debased position by another who at a point in time posesses greater power than oneself.
  • Humiliation can involve anger over one’s lowered status.  (Gilbert & Andrews, 1998)

References

Anderson, E. (1994) The Code of the Streets. The Atlantic Monthly 5 81-94

Cohen, Vandello, Rantilla (1998) The sacred and the social . Cultures of honor and violence. In P Gilbert, B Andrews (Eds.) Shame: Interpersonal Behavior, Psychopathology, and Culture pp.261.

Gilbert, P. E., & Andrews, B. E. (1998). Shame: Interpersonal behavior, psychopathology, and culture. Oxford University Press.

Gilligan, J. (2001) Preventing Violence. London: Thames & Hudson.

GILLIGAN, J.. (2003). Shame, Guilt, and Violence. Social Research, 70(4), 1149–1180. Retrieved from http://www.jstor.org/stable/40971965

Herbert, B. & Gilligan, J. (2014) Bob Herbert’s Op-Ed. TV: Dr James Gilligan on our Culture of Violence. Youtube Video. https://www.youtube.com/watch?v=IozZsuCfiZo

Retzinger, S. M., 1995 Identifying shame and anger in discourse. American Behavioural scientist 38(8) 1104-1113.

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

Illustration: The Dialogical Self and Contact Cycle

Polster and Polster (1973, p. 176) in their book Gestalt therapy integrated explains the syntax of the contact episode as moving through eight stages:

  1. the emergence of a need;
  2. the attempt to play out the need;
  3. the mobilization of the internal struggle;
  4. statement of theme incorporating the need and the resistance;
  5. the arrival at the impasse;
  6. the climatic experience;
  7. the illumination;
  8. the acknowledgment.

This cycle may last for only a minute, or it may play out for months and years. When the circle is not complete, there exists an incomplete gestalt, or unfinished business. In therapy the client is supported to complete pressing needs that are open. The closure of the cycle can bring about catharsis.

This sketch describes the dialogical self in contact with the environment and the resistances that denies the self from experiencing the environment, thus denying the needs of the self. Included are also the introjects that arise from past traumatic experiences and creative adjustments that ensues when these resistances are in play.

Dissociation   is known to be another contact interruption strategy. The person who is dissociated avoids contact with the stimuli, by retreating in his/her mind. This is a strategy of children who feel trapped in a situation,  but it  can also be something we do, like daydreaming  while pretending to be attentive in school..

contact cycle, gestalt therapy
The dialogical self in Gestalt Therapy, Contact Cycle illustrated

Adapted from :
Clarkson, P., & Cavicchia, S. (2013). Gestalt counselling in action. Sage.