Therapeutic Autoethnography is founded on Autoethnography, an emergent field in qualitative research. Therapeutic Autoethnography engages the practitioner as a researcher in the field of the psychotherapy situation. It is a practice-based, practice-driven, practice-informed qualitative research method. It provides an in-depth understanding of what goes on in the diverse naturalistic setting of psychotherapy practice. In Therapeutic Autoethnography, the field being investigated is the therapy situation, which encompasses the individuals attending the session, the therapeutic alliance, and its environment. In the role of researcher, the therapist creates aesthetic accounts of their experiences in the field with their client(s). The writing process is deliberately reflexive and integral to the method. This act of creative writing is a heuristic process where new insights emerge for the researcher. This thesis demonstrates how Autoethnography can be applied as a practical methodology for psychotherapy case study research, especially for explicating the implicit nuances in therapy.
Keywords: Autoethnography, Therapeutic Autoethnography, psychotherapy research, case study research
Understanding Salomo Friedlaender’s Creative Indifference: A Psychotherapy Case-Study.
Salomo Friedlaender’s Creative Indifference, or Schöpferische Indifferenz, first published in 1918, is a founding philosophy of Gestalt therapy that has invaluable implications in the process of psychopathology in the psychotherapeutic process. This article features a psychotherapy case study of a client who has been diagnosed with Major Depression and Atypical Anorexia Nervosa. The case story is written by the therapist using Therapeutic Autoethnography, a method of inquiry into the psychotherapeutic process. Writing this case study in an evocative aesthetic form, the understanding of Creative Indifference is fleshed out and enriched. Story and theory are interwoven reflexively to illuminate how aspects and meanings of Friedlaender’s philosophy of Creative Indifference, the centering in the here-and-now, the fertile void and zero point, apply to the real-life, naturalistic situation of psychotherapy practice. Though the case study details but a portion of the client’s work, one can grasp the atmosphere from which the client’s pathos is made visible. Creative Indifference facilitates this process of psychopathology in a powerful way, expanding our understanding of suffering beyond the traditional attitude of clinical diagnosis.
Keywords: autoethnography, psychotherapy case studies, psychotherapy process research, gestalt therapy, aesthetic inquiry
Excerpt from the Case Study: “Stuck”
The leather armchair seems massive as she slumps into it. Min looks almost childlike, dangling her chunky Dr. Martens covered feet. “I just feel hopeless and devastated,” she says. “It’s my birthday today, and I thought I bought myself a gift.” That “gift” , she explains is the “gift of therapy”. I would have mistaken her for another cosplay preteen, wearing a head of neon green dreadlocks, had she not revealed that today she turns 29.
“What do you do here in Vienna?”
“I work at a Konditorei.”
“Are you studying here as well?”
“Not any more. I actually moved to Vienna for study at a university. The exams were too hard and I got stuck.” Min explains that she’s been living in Vienna for three years, shares an apartment with 3 Russian-speaking housemates and has few friends here.
This is our first moments together and I find myself mesmerized by the girl looking back at me. The small body, the square shaped face, the big head that tilts to the left as she smiles reminds me of someone familiar. Very familiar.
I ask her if there is anything that she needs to know about therapy at this point.
“Uh. This is my very first time doing therapy, and I don’t know what I want.”
“How did you choose to contact me?”
“Oh… I saw in your profile that you are social, with group therapy and all… and that you were doing something cultural.”
“I had to think for myself,” she says, “but now, as an adult, I feel dependent.”
A psychotherapist’s lived experience in-session with an asylum seeker and translator: An autoethnographic case study
Featured in this article is a psychotherapy case study recounted from the lived experience of the psychotherapist working with an asylum seeker from Afghanistan, with the help of a translator. The method applied is an aesthetic inquiry adapted from Autoethnography which engages the practitioner as the researcher who enters the ‘field’ of the therapy situation. The reflexive writing of the case story, which is integral to the method, sets off a heuristic process, integrating research and practice. Reading this case study, one may grasp the nuances and the atmosphere of an otherwise linguistically challenging therapeutic situation. The story and Gestalt therapy theory are weaved together, which makes palpable, intangible aspects of the therapeutic process.
Keywords: autoethnography, psychotherapy case studies, psychotherapy process research, gestalt therapy, aesthetic inquiry
“I want to be confident, but something in my past is stopping me,” Zaya translates.
I give Ali a nod to acknowledge what I am hearing. He smiles back at me. His jacket hangs on a clothes rack by the door. This is the start of our second session.
Ali’s opening sentence this morning feels like an invitation. Ali stands by a threshold between the future and the past. He points us in the direction of the past. I see him shudder. I shudder, though I do not know what it is I am seeing. I am interested, in earnest. I am also wary. I lean back.
I ask Ali what he meant by the past stopping him from being confident.
“Uncle.” Ali explains that uncle is the younger brother of his father. Ali was put in the care of uncle and his wife when he was 9 years old. Till he turned 18, Ali lived with the couple and their daughter, who’s a little younger than Ali. “I always hear uncle say, ‘you will come to nothing. Nothing’.”
“What would you say to him right now, if he is sitting here?” I ask.
Ali clenches a fist, then promptly holds it down with the other hand. “I have no words, nothing.”
“Yes.” I say. I give space to the young man’s rage. Zaya reaches gingerly for a filled paper cup and takes a sip. Ali and I follow suit.
I ask him how he got to be put in the care of uncle.
“After school I play football. The playground is near my house. One day, I was playing football, then the bomb of the Taliban exploded on our house.” Zaya translates this, ice cold. They were all home when it happened; Ali’s father Zabi, his mother, Fatemeh and his baby sister Khatere. Ali’s voice cracks as he mentions the name of his baby sister. He stares, glassy-eyed, blank.
The skin on the back of my neck tingles. I glance towards the radiator by the window, as if to check if it was turned on properly. No, the air in the room is not cold. I am being touched by phantoms who have now descended amongst us. I search my bag for paper, only to find a dog-eared stack of neon coloured post-its. I write, “Zabi”, “Fatemeh”, “Khatere”, on three little sheets, careful to get the spelling right. I lay the post-its on the coffee table. I feel tears well up in my eyes. The space between us is saturated.
“How… are… you?” Ali asks me in English, then giggles.
“Thank you, Ali,” I say. “I slept well, so this morning you have my fullest attention.”
“How about you, Zaya,” I ask.
I catch a slight blush in her cheeks, as she giggles, “very well.”
“Ali says that he doesn’t sleep well. For example last night he had a bad dream. A nightmare.” Zaya translates.
“There is the mafia,” Ali says, “who is raiding the castle. Me and my friends are hiding in it. The mafia shoots me. I’m almost dying and my friends save me. My father is there. Oh. But that is only for a short time. I fall out of the window and run away.”
We share a round of chuckling. I offer Ali and Zaya a suggestion to do a chair work. Zaya’s eyes lights up. I’m aware that she had read much about the Gestalt therapy method of working with dreams. “I’m not sure if you’d like to try this exercise.” I say to Ali, who is probably sensing Zaya’s interest.
“Yes. Yes,” is his reply.
“Well, if at any time either of you are feeling unwell doing this dreamwork, say stop.” I tell them.
“Yes. Yes,” he says.
Zaya translates, “What do I do?”
So we set the stage with empty chairs around us. I am thankful for having booked this larger room again this morning. Ali puts a chair for “the mafia” a distant right from his. He then says that the rows of chairs stacked up along the wall of the room are where his friends sit. He takes the last chair and places it close behind him slightly to his left; there Ali seats his father.
Chew-Helbig, N. (2022). A psychotherapist’s lived experience in-session with an asylum seeker and translator: An autoethnographic case study. European Journal of Psychotherapy & Counselling, 1-16.
Find this Journal here: https://www.tandfonline.com/doi/abs/10.1080/13642537.2022.2156138
Writing evocative case studies: applying autoethnography as a research methodology for the psychotherapist.
This is an introduction to the application of autoethnography, a qualitative research method, an aesthetic inquiry into the psychotherapy process. The method engages the practitioner as researcher-autoethnographer who enters a field, which is their client’s therapy process. The aim is to derive insights and deepen the understanding of process, theory and diagnostics from psychotherapy sessions in practice. The therapist creates a reflexive account of their experiences, recording this in their session notes, which are also the field notes and the data. As an autoethnographer, the therapist begins therefrom a process of creative writing. The writing process is reflexive, and aesthetic. Integral to the research method, the act of writing forms a hermeneutic circle where new insights into the phenomenon of therapy happen for the researcher. The writing is created as an art form, usually a story or poetry. The result of this method is a written, evocative, aesthetic representation of the therapy process, based on the phenomenological experience of the practitioner. Demonstrating this method, a single case study of an online Gestalt therapy session of a male client diagnosed with depression and borderline personality disorder is featured in this article. The outcome of this form of aesthetic inquiry is the embodiment of psychotherapy theory through the aesthetic sensibility of the therapist-researcher.
Keywords: autoethnography, psychotherapy case studies, psychotherapy process research, gestalt therapy, aesthetic inquiry
In Gestalt therapy practice, aesthetic sensibility to the atmosphere is instrumental to the therapist, in order that they can attune to the movement of the phenomenological field (Francesetti, 2015). This is where this research methodology aligns with Gestalt therapy practice. Theory of the phenomenological field is central to Gestalt therapy (Parlett, 1991; Staemmler, 2006; Francesetti, 2019; Philippson, 2009; Robine, 2006; Spagnuolo Lobb, 2013) as it is in psychology (Lewin, 1951). Attunement to the aesthetics of the phenomenological field allows therapists to move beyond the mono-personal, third-person attitude of diagnosing the client’s psychopathology using manuals like the DSM (American Psychiatric Association, 2013) and evaluating clients using psychometrics. It goes even beyond the bi-personal, relational attitude of inquiry into the therapeutic alliance (Greenberg, 1986; Clarkson, 2003; Jacobs & Hycner, 2009; BCPSG, 2010). Aesthetic attunement brings the psychotherapeutic process beyond therapist and client, into the atmospheric realm of the phenomenological field of the here-and-now.
Chew-Helbig, N. (2022a). Writing evocative case studies: applying autoethnography as a research methodology for the psychotherapist. The British Gestalt Journal, 31(1), 35-42.
Find this Journal here: https://www.britishgestaltjournal.com/shop/british-gestalt-journal-311 or request a copy from me.
This article is an introduction to my recent research in psychotherapy. I have streamlined this qualitative research method which engages the practitioner as the researcher or autoethnographer. The aim is to share and gain insights into the phenomenon of the psychotherapeutic process from the live-in perspective of the therapist. Watch this site for the release of my doctorate thesis, which will be soon released.
Lecture at CONFERENCE 2021
Here is the transcript of my lecture in the conference above:
I want to thank the organizers of this conference for inviting me today and the editors of the European Journal of psychotherapy and Counselling for accepting my article.
It is a pleasure to be here to share this aspect of my work.
I work in Singapore, and the time here is now 6:30 pm.
PROFESSIONALLY I identify myself foremost as a practitioner of psychotherapy. Currently, tail end getting my doctorate the Sigmund Freud University in Vienna.
I can say that
Gestalt therapy found me when I was already in my 40s; by then, I had lived for more than a decade in Austria.
It was then that I stumbled into a Gestalt therapy workshop.
I was impacted by the contact I made with others at that workshop. Something happened. Something changed. I changed.
I am aware that that change didn’t happen just because several people grouped together. Change occurred because there were therapists there who were attuned to what was present; they were dedicated to the work.
I consider myself lucky that the first therapists I met made such an impression on me.
My curiosity leads me to enrol in the university (after having left school 25 yrs before with a Biochemistry degree), I yearned to grasp what I had experienced. I tried to read about psychotherapy, how therapy works, and how therapists work. But nothing could justly explain my experiences as a client in those “magical moments” of treatment.
So, years later, having put myself through Masters and now the doctorate program in psychotherapy science,
I find myself still a seeker.
Notice that I am not referring to myself as a researcher but a seeker of understanding
of what psychotherapy is… versus… what the world thinks psychotherapy is for…
of what therapeutic change is… versus… what kind of change is expected of therapy.
And this leads me
I am proposing a method of inquiry into the psychotherapy process featured in my doctorate dissertation.
My contribution to this issue of the EUJPC is a distillation of this work.
There are two parts to this:
the case story… which reflects a therapeutic encounter that is relevant to the topic of diversity, inclusion and the psychotherapeutic process. It a psychotherapy case study recounted from my lived-experience as the psychotherapist working with an asylum seeker from Afghanistan, with the help of a translator.
the method of inquiry that i used, is an adaption of Autoethnography.
I shall very briefly describe the research methodology, and then introduce the case story.
The method of inquiry that I use here is adapted from Autoethnography… which is a qualitative research method traditionally applied to social studies.
To apply Autoethnography in psychotherapy case study …
I needed to make several definitions and differentiations
I give this method the name, Therapeutic Autoethnography
<< See the infographic>>
Therapeutic Autoethnography is what I would describe as an aesthetic inquiry and an aesthetic representation of the studied psychotherapeutic encounter.
the result is a story, an art form,
What you will not get is a report,or an analysis about what has happened in the session,
but a story that evokes in the reader a sense of how it feels like to be there with the client in that encounter.
It is entitled Undercurrent
Is a story of diversity and the will for inclusion within the therapeutic encounter
The case story that I have written for this issue is based on my experience working with a patient some years ago, with whom I shared hardly any word with.
Culturally we were different.
This is the year 2018… before the COVID pandemic happened, It was the time of the refugee crisis in Europe .
Ali, the client, was about 30 years old, from Afghanistan, seeking Asylum in Austria.
He was brought to the psychotherapy clinic diagnosed with PTSD.
In this therapeutic field there was also the therapist, myself, and I am from SG. In this story, I am also the practioner and autethonographer.
Since we spoke in different languages, we were accompanied by a Translator, Zaya, who, was about my age, a mother of 2, and she was from Iran.
Together we were foreigners who happened to have met in Austria.
So you can appreciate how each of us in this encounter bring in our own phenomenological fields. ANd this is beyond language, gender, socio-status and culture.
In this article I weave the story from what I experienced in the sessions (which lasted 9 months) with Ali and Zaya, how we were moved even though language seemed a barrier.
How we brought the suffering that was hidden to the surface.
Time here is too short to read the story; you can read it in the article.
But I shall share with you the concluding paragraph.
“We gathered for nine months, three months longer than we had contracted to work
together. In this field, a story and plot emerged. Ali’s plot toggles between contents of his past and his future. From his past we hear of his suicide attempts, the violent treatment he endured from his uncle, the friends he had lost in the war. We hear of his concern for the women he had left behind in Afghanistan who had protected him— his uncle’s wife, and the mother of his friend, also named Ali. We hear also of betrayal. Ali’s future promises hope, despair, and uncertainty. What we had together in the therapeutic situation was in the here-and-now, like a pivot, holding space in an undifferentiated situation.
One can see how
The writing is different from other forms of academic writing, and it comes across as being an easier read.
Oftentimes Academic articles that are easiest to read are the hardest to write. in many sense… it takes courage and creativity to write reflexively.
Dialogue analysis of a filmed Gestalt therapy session: an introduction to a method
Psychotherapy process research takes us beyond answering the question, ‘does psychotherapy work?’ This area of research aims to study the hows and whats that happen within the psychotherapeutic session that potentiate change. The psychotherapeutic dialogue is an important source of data for psychotherapy 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 four pillars: 1) that dialogue is implicit action between persons that is supported by explicit verbally uttered content; 2) that the individual’s mode of interaction within the dialogical dyad reflects the person’s relationship patterns; 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, Bob Resnick’s video-recorded Gestalt therapy session entitled ‘A Rose on the Grave of my Family’ was selected. The transcription of the session was 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 process research, dialogue analysis, psychotherapeutic alliance, Gestalt therapy.
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.
Using the Rupture Resolution Rating System (3RS) for microanalysis of the psychotherapeutic dialogue. This article describes the use and function of this instrument in psychotherapy research.
The psychotherapeutic dialogue is the tangible aspect of the psychotherapeutic alliance. Within this alliance is the healing aspect of psychotherapy. An alliance rupture is defined in this manual as a deterioration in the alliance, in the sense that these occurrences are manifested by ab apparent lack of collaboration between patient and therapist on the task forward. While the concept of rupture may have like a “negative” connotation in other alliances, ruptures are essential parts of the psychotherapeutic alliance.
The absence of rupture and repair in a therapeutic session is a sign of confluence between therapist and client; whereby both parties give in to each other’s requests throughout the session, without question or challenge. These mainly confluent, rupture-less relationships in psychotherapy do not lead to healing at best, and at worst, may lead to the client being dependent on the therapy.
By rupture, the authors Eubanks-Carter et.al (2014) reiterate that it is not about lack of agreement, but lack of collaboration. The authors are also aware that agreement on the surface may actually be withdrawal, which is a kind of rupture.
“Note that a lack of ruptures is not necessarily the same as effective therapy. A patient and therapist could be in agreement and be working together very smoothly, but pursuing goals and tasks that are not the best choice for the patient’s situation. When coding ruptures, the focus is on the quality of the collaboration and bond between the patient and therapist—not the quality of the therapist’s case conceptualization, choice of treatment approach, or adherence or competence.” (p. 4)
Ruptures may be outside the consciousness of the therapist and client. In severe cases, ruptures can lead to dropout or failure of treatment.
2 subtypes of ruptures:
withdrawal ruptures : moving away the therapist (avoiding questions, etc.) or moving towards the therapist in a way as to avoid experiences (being overtly appeasing, etc), avoiding the actual work of the therapy.
confrontation ruptures : moving against the therapist, expressing anger, dissatisfaction by trying to pressure or control the therapist /therapy
Both therapist and client contribute to ruptures.
The coding system looks at the patient’s behaviors as markers of ruptures.
Resolution process is a process by which the rupture is repaired. This is a opportunity for rebinding the alliance, and reinstating new goals.
Resolution strategies are measures taken by the therapist to initiate the resolution process.
Signs of rupture (p. 5):
Patient and therapist are not working together collaboratively and productively. They
are “not on the same page.”
There is strain, tension, or awkwardness between patient and therapist.
Patient and therapist are misaligned or misattuned.
Patient and therapist seem distant from each other.
Patient and therapist are working at cross purposes.
Patient and therapist are acting friendly, but you sense tension or disagreement beneath the surface, such that the friendliness seems to be a pseudo-alliance.
Patient and therapist seem to be caught in a vicious cycle or enactment.
You feel very bored while watching a session. This might be a sign that a withdrawal rupture is occurring
Eubanks-Carter, C. F., Muran, J. C., & Safran, J. D. (2014). Rupture resolution rating system (3RS): Manual.
“The processof psychotherapy represents anything that can be conceptualized as a constituentof the psychotherapeutic treatment; more specifically, it refers to all of the events that, during the course of a treatment, occuras part of the therapy sessions and/or may be related to these sessions (Hill and Lambert 2004 ; Orlinsky et al. 2004 ). These events may refer to any domain (physiological, affective, cognitive, behavioral, etc.) that is ascribable to the client, to the therapist, and/or to their relationship. This definition is highly inclusive and, thus, analogous to the definition of the treatmentprocess that is given by Orlinsky et al (2004 ); therefore, it should be distinguished from the more specific changeprocess, which refers to those specific aspects of the treatment process that represent any clinically meaningful event “through which clients or patients are hypothesized to improve”(p. 312; also see Greenberg 1986 ; Rice and Greenberg 1984 ).”
“The outcomeof psychotherapy represents anything that can be conceptualized as a clinical effect of the psychotherapeutic treatment process; more specifically, it refers to those clinically meaningful changes that, during the course of a treatment and/or after its completion, may be observed as resultsof the therapeutic process, as defined above. These changes refer to the client’s problematic domains (e.g., physiological, affective, cognitive, or behavioral) that represent the treatment’s target, and should be observed outside the treatment situation (Orlinsky et al. 2004 ).”
Gelo, O. C. G., & Manzo, S. (2015). Quantitative approaches to treatment process, change process, and process-outcome research. In Psychotherapy Research (pp. 247-277). Springer Vienna.