Tag: gestalt

What is the purpose of emotion?

Every theoretical system has its biases, and gestalt is no exception. Along with gestalt’s bias towards here and now experience, gestalt also has a bias towards emotion and feeling.

There is a general wisdom in gestalt that emotions are Good Things, and that feeling one’s emotions is better than not feeling them. Whilst I agree with this outlook, I had tended to be fairly vague on why I agree with this outlook. So a while back I explored my thoughts about the nature of emotion in order to arrive at a better understanding of my stance on the matter as distinct from what I’ve simply picked up (ie introjected) through training, practice, supervision, and my own therapy.

What I arrived at is a relatively simple maxim: emotions mobilise situations for action.

A simple maxim, but one that requires some unpacking.

Let’s start with another foray into my good friend, the Online Etymology Dictionary:

Emotion: 1570s, “a (social) moving, stirring, agitation,” from M.Fr. émotion (16c.), from O.Fr. emouvoir “stir up” (12c.), from L. emovere “move out, remove, agitate,” from ex- “out” (see ex-) + movere “to move” (see move). Sense of “strong feeling” is first recorded 1650s; extended to any feeling by 1808.

And compare with Cambridge Dictionaries Online:

Emotion: a strong feeling such as love or anger, or strong feelings in general.

Emotions are active forces. Whilst the dictionary definition above captures the sense of strong feelings, it loses much of the background sense of emotional activity. All emotion is bodily activity. That doesn’t mean I reduce emotion to mere ‘chemical imabalance’, only that I recognise the physical basis for the experience of emotion. All emotion involves physical, bodily activity. Hence the background sense of agitation and outward movement expressed in its etymology.

Given that any mobilisation of the body involves a significant investment of energy and resource, the kinds of activity that emotions support deserve attention. This is where simple here and now description of what actually happens comes into its own. What actually happens when someone doesn’t just feel sad but emotes sadly? What happens when someone emotes angrily or expresses fear or hate or love?

What happens is that the situation they are part of responds.

At the heart of gestalt sits field theory, the observation that behaviour is a function of an organism in an environment. In crude terms, my issues are the result of my interactions with my environment, making my behaviour as much an expression of my environment as an expression of myself. I cannot be separated from my environment; at all times, I must exist in some situation or other.

Emotions are distinct from feelings in that where feelings are sensations, emotions are actions that arise out of feelings. There is a notable difference between feeling angry and being angry. That difference is physical activity. Feeling angry is becoming aware of a certain range of sensations that make a range of activity possible. Being angry is an elevation of those potentials into actual bodily expression.

The end result, if a feeling is allowed to grow into an emotion, is that some outward movement is made. Expressions of anger tend to involve raised voices, growling noises, and hitting things. Expressions of sadness tend to involve fallen faces, shedding tears and softer voices. And both have different effects on the situation a person exists within.

When someone cries with sadness, the most common supportive responses tend to be to offer comfort and to ask what’s wrong. The emotion of sadness mobilises the situation for supportive action. When someone growls with anger, again a common response is to find out what’s going on, what’s got that person mad. Where there’s a clear physical threat, the situation can then divide into support for physical violence and peacemaking. Anger mobilises the situation for conflictive action and resolution.

These are simplified examples but my general point is that emotion isn’t just about feeling something in a private internal world. Emotion is physical activity that gets responded to; British culture may be commonly described as generally repressive of emotional expression but even that is clearly a response. And a very instructive response. Where emotional expression meets with hostility and repression the lesson is clear: there is no support for your feelings here, this situation will not mobilise to support you. Other strategies then have to be found for dealing with forbidden feelings without emoting them.

So, how does this underpin my opinion that emotions are Good Things?

Because emotional expression allows for an open and honest expression of need. The result of suppressing emotion isn’t that the feelings out of which emotions arise go away (though we may block our awareness of them); the result is that we find different ways of coping with them that, to a greater or lesser extent, result in our genuine needs being frustrated. And repeatedly frustrated needs become cravings that continue to seek completion in the present out of our awareness.

I say open and honest because I’m not suggesting that emotional expression should always result in a meeting of needs. Rather, it allows for open and honest negotiation, based on the complex needs of other people, and the range of support available at the time. Emotional expression simply allows people to be aware of the range of need in a given situation. When emotions are suppressed, the underlying needs continue to seek completion but secretly and manipulatively.

Feeling one’s emotions instead of not feeling one’s emotions means knowing what one needs instead of not knowing what one needs. Furthermore, being able to express emotions means that when what you need is available, you will be able to get it. When emotions are suppressed to the point that feelings give rise to an automatic shutting down of emotive activity, it becomes impossible for the original need to be met. Think of your need as sitting in a room with a locked door; it isn’t enough to know intellectually what’s behind the door and what it needs. At some point, to be truly satisfied, the door has to be opened to allow what’s needed to get through. Feeling is becoming aware of the need behind the door; emotion is opening the door.

In order to enjoy the taste of your food, you need to chew it and savour it; physical activity that takes effort. Likewise, in order to enjoy human interaction, to be truly satisfied as a social animal, you need to engage in another physical activity that takes effort; emoting.

So, emotions are Good Things, and their purpose is to mobilise situations for action.

~ ~ ~

Photo credit: Emotion by Peter Dutton.

Resistance is fertile

Resistance is fertile

At the heart of every course of therapy sits a struggle between change and resistance.

Traditionally, the therapist is seen as an agent of change. In this view, it is the therapist’s job to help bring about change, be that the explicitly desired change of the client, or an unwanted albeit necessary change.

In gestalt therapy, this agent of change view of the therapist is rejected as a barrier to organismic self-regulation. By positioning myself as an agent of change for the client, I encourage a conflict between two sides of the client to play out as a conflict between the client and me.

Which in traditional psychoanalysis is the whole point of the analysis; to evoke the core transference that is taken to be the root of the problem, and resolve it. This sets the scene for successful therapy (the transference is resolved by change winning over resistance), and unsuccessful therapy (resistance overcomes change, and the transference stays in place).

That’s why in gestalt we talk about working with resistance by understanding the environmental context that demonstrates its necessity. And we approach that work with an openness to the range of possibilities that work entails: maybe change will win out over resistance, maybe resistance will win out over change.

Of course, the gestalt therapist smiles wryly about all this because the very act of exploring the struggle between change and resistance is in itself a change to the previous situation of keeping the conflict out of awareness. So whatever happens, the paradoxical theory of change wins out because just to contemplate one’s struggles is to act from organismic need.

The difference is that the gestalt therapist introduces awareness into the conflict. And our observation is that awareness supports response-ability. Resistance is no longer a kind of abstract disembodied force. It is me, resisting. “I can’t” becomes “I won’t”. I won’t because I don’t want to. I don’t want to because you’re asking too much of me, it’s hard, I’m afraid. Whatever is in there, awareness draws it out.

And that isn’t a magic cure; it’s not a trick. I don’t for a second think that, once we draw out the difficult thoughts and feelings and memories and fantasies that generate a resistance to some otherwise desired change, a sunbeam will break through the clouds and my client will see the light and rise up a different person. That’s not how it works; that’s not what this is all about.

Much of the time (maybe even most of the time), the end result of bringing that conflict into awareness is returning to the comfort of the starting point, of not changing.

But the power of changing I can’t into I won’t mustn’t be underestimated (and it is a therapist’s duty to explore in good faith whether that “I can’t” is in fact true; a blind person isn’t resisting sight).

It plants a seed. Maybe that’s a seed that never germinates because the end result of that conflict is a choice to give up on that previously desired change. In which case, rejoice! The gestalt is complete! Or maybe that conflict demands further rounds of struggle. In which case, “I won’t” becomes a question of motivation and support. What do you need to make this change possible? How can you get that support? Who could you turn to? What’s missing?

In the course of that exploration, the past must be contended with as unfinished business in the present. So someone told you years ago that you could never do it? How do you keep that memory active now? What is their hold over you now? It’s shocking, actually, to realise that a great number of disembodied voices holding us back turn out to be children. We introject them at a formative age, then keep the message alive as a conviction of truth. Then one day, you put that message back into context, and you’re a grown up dealing with the memory of a 7 year old child.

Resistance is also a deeply political phenomenon. When protests spring up, it’s usually an attempt to resist people in power. The French resistance against Nazi occupation stands out in Europe as an archetype of resistance. And as we’ve seen with police sending undercover operatives to infiltrate campaign groups, and the use of agent provocateurs to disrupt popular movements, the State often responds to resistance with both overt and covert violence.

This is not metaphorical. This is actual resistance in the form of one set of human beings exerting their will against another set of human beings. The hellscape that is the ongoing civil war in Syria began with resistance.

Resistance is ultimately about a clash of wills, and a loss of dialogue. The gestalt therapist’s aim is to bring that clash of wills into awareness, where it has the opportunity to develop into a conversation. Maybe that eventually supports a negotiated settlement, maybe it doesn’t.

Whatever happens, the principle objective is awareness.

~ ~ ~

Photo credit: featured image is “resistance is fertile” by Nicolas Nova.

What is gestalt psychotherapy?

From time to time, I like to return to first principles to remind myself of what I’m doing, and to what end. I haven’t written a “what is gestalt therapy?” post for a while, so here we go.

“What is gestalt psychotherapy?” is really three questions in one. And I think those questions are best approached through a consideration of the words we’ve decided to use to refer to what it is we (as gestalt psychotherapists) are doing. It’s a different way of explaining gestalt to the inside-out way of starting with how I’ve been trained to do gestalt therapy.

What is psychotherapy?

I think psychotherapy is best understood by reference to its etymology. Psychotherapy is a word with two roots.

The first, psycho, is a common prefix generally taken as relating to anything to do with the mind. Its own origin is in psyche, which refers to soul in the sense of “animating spirit”. Within the context of what psychotherapy *does*, it is this sense of the soul as animating spirit that offers a better fit than the more cognitively-weighted sense of mind.

The second, therapy, has its origin in the Greek therapeia, concerned with curing and attending to in a medical sense. It can be used to mean healing in the widest possible sense, but I particularly like the description “attend, do service, take care of”. If I ground myself in the lowest common denominator for what I do in actual therapy sessions, “attending” stands out as the most basic theme. To the point that, for some, literally feeling able to attend the therapy session in the first place is the primary therapeutic issue.

Overall then, I take psychotherapy to mean something like, attending to the animating spirit. If I lean into my more mystic side, this can become soul healing. If I lean into my more rationalist side, this can become treating the mind. But right there in the middle, I think “attending to the animating spirit” points towards the range of activity that is covered by the term psychotherapy.

What is gestalt?

In the most basic sense, gestalt is a German word that seems to get translated into English most roughly as “shape” or “form”. More descriptively, a gestalt can be called a configuration or structure that is more than the sum of its parts. Neither of these quite captures the sense of gestalt that comes from the consideration of gestalt psychology that inspired the original naming of gestalt therapy.

For me the gestalt concept is the sense of an overall meaning that emerges out of, and then organises the ongoing experience of, a combination of elements. It’s about how we come to perceive something as a recognisable object by breaking it down into specific features that combine in a certain way.

Suppose you take a load of lego blocks and make a dinosaur. Then you take the dinosaur to pieces and use the exact same blocks to make a spaceship. The parts you are using are the same in both, but the way they are arranged is different. And, crucially, the starting point for both is the final whole; it is the meaning of dinosaur or spaceship that organises my arrangement of the lego blocks into a shape.

So gestalt isn’t just about meaning in a general sense; it is about a meaningful whole organising perception. It’s about context shaping meaning. Gestalt Therapy could just as well be called Context Therapy and not lose much in the translation.

Overall then, I take gestalt to mean something like a meaningful context. So when we talk about the gestalt of something, we are talking about the contextual qualities that give that thing its meaning, the key features. We’re describing the perceptual cues that explain how we know that this something is the something this is. And we are also describing how, once the overall context is established, it shapes how we understand the things that arise within it.

What is gestalt psychotherapy?

Putting the above together, gestalt psychotherapy emerges as a way of attending to the animating spirit by investigating the meaningful context from which that spirit emerges.

This is core to viewing what might otherwise be called neuroses, issues, or behavioural problems, as creative adjustments. Rather than work in the spirit of solving problems, gestalt therapy involves working in the spirit of seeking out the meaning of behaviour and experience. That is, I ask myself, “what is the context that makes sense of this?”.

This in turn connects two important aspects of gestalt therapy theory: field theory and the here and now. My starting point for understanding field theory is the phrase, “behaviour is a function of an organism in an environment”. Not only does this emphasise contextualising what is happening, it also emphasises the need to work in the here and now, on what is happening right now.

Overall then, I take gestalt psychotherapy to mean something like attending to the meaningful context from which the animating spirit emerges. Which in practice is about attending to the relationship between the animating spirit and that context.

I’m still not sure what that should sound like as an elevator pitch; I’m not sure that, “I investigate the relationship between a person’s animating spirit and the meaningful context from which it emerges” is going to be cutting much mustard.

For now though, something like, “make sense of troubling experiences by putting them in context”, might work as an ice-breaker for what gestalt therapists actually do in practice.

~ ~ ~

Photo credit: Context is King by Rebecca Jackson

Resentments and regrets: working with unfinished business.

Any incomplete gestalt is unfinished business demanding resolution. Usually this takes the form of unresolved and incompletely expressed feelings. Patients are encouraged to experiment with finishing business which heretofore was unfinished… Gestalt therapists have found that resentments are the most frequent and meaningful unexpressed feeling, and often deal with this with a game in which communication is limited to statements beginning with the words “I resent…” Gary Yontef – Awareness, Dialogue & Process (1993; p79)

When the environment fails in some emotionally significant way, disappointment is a natural organismic response. When that disappointment is not acknowledged, is not expressed, or is held onto, it grows bitter and transmutes into resentment.

Maybe I come to resent someone for not living up to my expectations, or for not doing something I wanted them to do, or for doing something I didn’t want them to do. Maybe I come to resent some aspect of my self for not being the way I want it to be. This part of my self then becomes other to me; I resent my body for not fitting a social ideal, or I resent my intellect for not being sharp enough, etc.

On the other hand, when it is I who fails in some emotionally significant way, that disappointment transmutes into regret. These regrets become particularly poignant and important towards the end of life; important enough that a palliative nurse wrote a book called The Top Five Regrets of the Dying.

Just as with environmental failures, regrets can arise both from what I have or haven’t done. The main difference seems to be that regret focuses on actions I have or have not taken, whereas resentment arises from something being other than I want it to be.

Yontef’s experiment above is designed to focus awareness in order to create a clear series of figures. This is an exploration of figure/ground formation by taking a feeling as figure (resentment), then fixing it in place as a stable background, from which a series of other figures are invited to emerge (“I resent x; I resent y”).

This is particularly useful for people who defend against a specific feeling with deflection; changing topic, becoming tangential, or otherwise trying to prevent me from retaining a focus on the difficult feeling. Consequently, I have used variations on this experiment that include, “I am angry…”, “I am afraid…”, “I am sad…”. It effectively prevents avoidance by fixing the avoided feeling in place, in awareness. Though it’s important that the person I’m working with retains the power to end this experiment to prevent it being something I do to them.

My aims here include: developing self-support for the feeling under exploration by assimilating the realisation that episodes of experiencing that feeling are tolerable; developing the capacity to choicefully move towards and away from the feeling under exploration; general awareness raising (this is always in fact the primary objective of a gestalt therapy experiment, and a necessary condition for an experiment qualifying as “gestalt”).

Resentment and regret seem to be two important skeleton keys with the potential to unlock doors into a wide variety of unfinished business. Resentments will bring environmental failures into view; a landscape of disappointment. Regrets will bring organismic failures into view; the disappointed self. In both cases, the therapeutic task is discovering that which is necessary for completion.

~ ~ ~
Photo credit: Regrets by Magali M.

boredom

The psychopathology of boredom

Psychopathology is a great word. It has three parts: ‘psyche’ (the soul), ‘pathos’ (suffering), and the suffix ‘ology’ (the study of). If you’re ever writing about something in the context of its impact on human suffering, you can’t go far wrong by dropping in psychopathology (incidentally, given those meanings, that makes the meaning of ‘psychopath’ something like ‘suffering soul’). I digress.

As is perhaps becoming clear, I enjoy contemplating etymology; the origin and historical development of words. Not just their current meaning, but their historical origin and development over time. In the gestalt approach to therapy, we work with the present situation, and appropriate aspects of the person’s historical field come into awareness in relation to the material under consideration.

The reason I’m fascinated by etymology is because language creatively adjusts over time, and I think the history of a word has some bearing on its present meaning. In gestalt terms, I’d say that the present dictionary definition is in awareness, whereas the etymology is out of awareness (roughly correlating to the more analytic ideas of conscious and unconscious).

Consider the majority of the words you use every day: how did you learn those words? We don’t learn language from the dictionary, we learn language from people. The dictionary may fix an agreed definition for a given word, based on research into its current usage, but that makes the dictionary more like a camera taking linguistic snapshots than the actual source of a word’s meaning. I’m fascinated by etymology because it is the lived, relational story of the life and times of language. I suspect that etymology gives us a better idea of a word’s full meaning than the dictionary.

So, boredom.

Unfortunately, Cambridge Dictionaries Online define boredom as ‘when you are bored’ committing the cardinal sin of dictionaries by defining a word through reference to the word being defined. This vexes me. Fortunately, it defines bored slightly better: feeling tired and unhappy because something is not interesting or because you have nothing to do.

Now, ironically, my interest perks. How often have you been in or witnessed the situation in which one person (let’s call him Agamemnon) complains about being bored, and another person (say, Trixi) comes up with ideas for things Agamemnon could do, only for him to reject all of these ideas. There is never, incidentally, nothing to do; at the very least you can daydream.

From a gestalt perspective, a person is a process not a thing, so when I contemplate boredom, I look for the process. What is happening to bring about the feeling of boredom. The etymology of boredom gives us the process; boredom is the state (-dom) of being drilled into (bore). The word boring is a verb that has become used as an adjective; so the original sense is that if something is boring, then that something is actively doing something, it is boring into something.

The reason our dear Agamemnon ends up frustrating Trixi with his lack of interest in any of the available options is that it’s those very options that are boring into him. It isn’t simply that he lacks interest in his situation; it’s that his situation has become incredibly fixed and is starting to bore/drill/perforate into him, slowly and relentlessly.

So what is the psychopathology of boredom?

Agamemnon’s situation is one in which a number of the possible figures of interest have become fixed. Usually, when we lose interest in one figure, it recedes into the background and something else comes into the foreground. The shifting process of figure/ground is one ever-flowing dance of things moving from background to foreground to background according to the shifting needs of the person. Agamemnon is suffering because this process has stalled; whatever his needs are in this moment, he is unable to re-configure his immediate field around that need. If Trixi asked him in this moment ‘what do you need right now?’, it’s quite possible he’d only be able to answer ‘I don’t know’. Boredom is the state of being impaled on one’s current situation, and a (temporary) loss of the ability to create a new one.

So what’s to be done about this?

Trixi makes the critical error of suggesting possibilities to Agamemnon. Either the options Trixi offers are ones that he is already aware of (in which case, they are the very spikes on which he is already impaled), or they are possibilities he hasn’t been aware of, in which case he is largely unable to reach them on account of being impaled on his current situation. The trouble with being offered a new situation when one is impaled on the existing situation is that unimpaling onself is more painful than remaining impaled.

Remember: it isn’t possible to exhaust the possibilities of any given situation because the possibilities are infinite; it is only what one is aware of at any given time that is finite. Boredom is a state that we create for ourselves, without being aware of what we are doing or how (the clue here being the feeling that it is our situation that is doing something to us, which immediately points to a projection of some disowned aspect of ourselves). Consequently, there is the high likelihood that if Trixi succeeds in getting Agamemnon engaged in a possibility he is unaware of, he will most likely simply become impaled on the new situation once its novelty has worn off.

Ironically, the cure for boredom is to become interested in being bored.

There is a saying in gestalt, ‘work with the resistance’. Resistance is when I make a suggestion as a therapist and my client pushes back against it in some way. A classic example would be me asking ‘what are you feeling right now?’ (directing awareness towards emotion) and my client answering ‘oh I’m just thinking about…’ (deflecting awareness from feeling onto thinking). My client in this example is resistant to being aware of feelings. Working with the resistance means observing this process and becoming interested in it because that is where my client’s energy and interest is focused; in resisting the awareness of feelings. I’m not interested in overcoming resistance; I’m interested in directing awareness towards resistance because that is the fast-track to how my client has creatively adjusted. If someone deflects from feeling to thinking, they have good reason; my job is to support those reasons in becoming explicit rather than implicit.

Agamemnon isn’t simply impaled on his situation. Agamemnon is impaling himself on his situation. He is also frustrating Trixi’s attempts at creating a new situation. Boredom, then, can be seen as a resistance to two important things: first, the creation of a new/unfamiliar situation; second, the destruction (in the sense of de-structuring) of the old/familiar situation. Human experience is a constant process of structuring, destructuring, and restructuring.

I said the cure for boredom is to become interested in being bored, which I realise implies that I think boredom needs to be cured; I don’t. I think boredom expresses an important struggle between remaining in a familiar situation and entering an unfamiliar situation. In gestalt terms, this is an impasse, a deadlocked situation in which there is both potential for transition and resistance to that transition. Honouring this struggle means staying with the impasse and all the uncomfortable feelings that entails.

To that end, I suggest the following experiment for the next time you find yourself suffering from boredom:

Exaggerate your boredom and become as bored as you can be. What about your situation is boring? Make a list: x is boring, y is boring, z is boring. Tell each of those things in turn that they are boring you: ‘x, you are boring me; y, you are boring me; z, you are boring me’. You might find you want to say more to them: ‘x, you are boring me, and while I think about it, I also want to say…..’. If you find it difficult to say ‘x, you are boring me’ then what about saying that is difficult? Wherever you find yourself resisting, become interested in exploring how you resist, what you resist, why you resist.

Resistance is one of humanity’s most creative and beautiful processes. Even under the most crushing of tyrannies, still human beings are able to find ways of resisting apparently overwhelming force. Considering that the possibilities in any given moment of life are infinite, the sheer creativity involved in holding oneself in a state of boredom is astounding.

In fact, when I consider what it would be like to be cast adrift on that sea of infinite possibilities, what Milan Kundera would call the unbearable lightness of being, boredom suddenly seems fundamental to survival.

~ ~ ~

Photo credit: “boredom” by jean olahus. This post first appeared on my old blog, le chat d’argent.

eu referendum

EU Referendum: 3 gestalt therapy exercises for undecided voters

Tomorrow (Thursday 23rd June 2016), millions of us will go to a polling station, and decide the fate of our nation by putting a cross in one of two boxes in the much anticipated EU Referendum. Polling puts the result on a knife-edge, which means that the votes of undecided voters will decide the result.

I’ve had enough involvement in electoral politics now to know that a large proportion of undecided voters don’t make up their minds until they’re in the polling booth. So it could well be that the referendum result is ultimately decided in the quiet and dusty musk of the act of voting itself.

Which could be anything from terrifying to exhilarating depending on your disposition. Either way, I’ve made up my mind already so unfortunately, as an undecided voter, it’s your problem not mine!

Now, you will find any number of arguments for Leave and Remain, so if you’re still undecided at this point then the chances are that those arguments haven’t been helpful. I would like to offer a couple of exercises that might help you decide which way to go, and another for if you wake up tomorrow and still have no idea.

These are exercises I use in my therapy practice, and they mostly help people, so give them a try.

Exercise 1: get your Leave and Remain sides to talk to each other.

Sometimes, the best way to solve a dilemma is to intensify the discomfort of the dilemma until it resolves itself spontaneously. To use the popular gestalt therapy analogy of chewing, a dilemma is a particularly chewy mouthful of food that can simply need an epic amount of chewing before it’s broken down enough to be swallowed.

Take two chairs and position them. One will be the Remain chair, one will be the Leave chair. Keep a notebook to hand, and write down any thoughts/feelings/memories/fantasies that come up as you’re speaking (as therapist, I would normally interject at various points to ask “what are you aware of now?”, so think of the notebook as a therapist stand-in). The basic process is:

Opening up 

1. Decide which chair you want to start in.

2. Adopt a posture and voice that feels most appropriate to the side you’re embodying.

3. Take about 90 seconds to make an opening statement that overviews the case for your side.

4. Move into the other chair, and repeat steps 2 and 3.

Take some time to review any notes you’ve made, or just to mull over the exercise so far (do this in a new, 3rd position, not either of the Leave/Remain chairs). Start to get a sense of what each side means to you at this point. Then, when you’re ready:

Dialogue

1. Decide which chair you want to start in.

2. As Leave/Remain, what do you want to say to the other side? Take up to 60 seconds, focusing your awareness especially on what you feel as you speak.

3. Move into the other chair, and take up to 60 seconds to respond. Keep focusing your awareness on what you feel as you speak.

4. Keep repeating step 3 until you feel like there is nothing more to say.

Take some time to review any notes you’ve made / mull over this part of the exercise. Consider again what each side means to you now. Then, when you’re ready:

Closing

1. Decide which chair you want to start in.

2. Take about 60 seconds to make a closing statement that overviews the case for your side, incorporating any changes that might have arisen as a result of the dialogue.

3. Move into the other chair and repeat step 2.

Take some time to review any notes you’ve made / mull over this part of the exercise. Consider again what each side means to you now. Then, when you’re ready:

Adjudication

1. Now adopt a 3rd position where you are entirely you again.

2. Thank both Leave and Remain for their contributions and for an interesting discussion.

3. Now weigh up both the cases you’ve just made, and ask yourself the important question: which side did you find most convincing? That’s the way you need to vote.

Quite often, the drawn out process of this exercise will exhaust the energy you’ve invested in one side of the argument, revealing that the dilemma is relatively surface level. It can be hard to resolve this kind of dilemma by listening to other people, because other people will have a lot of energy invested in their favoured side, and that energy will invigorate that side of your dilemma.

You can also discover that both sides of the dilemma have equal energy but gain an insight into where the energy for each side comes from. You may well discover that one side comes from what you believe and are excited by, and another comes from an internalisation of someone important to you. Or that each side of the dilemma comes from very different motivations within you. The process of figuring this out often leads naturally to a conclusion that favours one side over the other.

Or not! In which case…

Exercise 2: sleep on it.

One of the many useful findings of sleep and dream research is the observation that dreams are heavily influenced by our preoccupations from the day. It’s even possible to train yourself to lucid dream (wake up within your dream and know that you’re dreaming) to the point of deciding when to lucid dream and what to lucid dream about (see Exploring the World of Lucid Dreaming).

One function of dreaming appears to be resolving incomplete situations from the very recent past (ie, the past couple of days). It’s possible to play with this function to help solve personal conundrums and dilemmas. Try this:

1. Write down a clear question on a small piece of paper, eg “how should I vote in the referendum?”.

2. Carry it around with you for the rest of the day, taking it out to look at it frequently.

3. Think about your dilemma as much as you can. Run through all the arguments for each side, over and over again.

4. When it’s time for bed, read something that summarises the dilemma well. If you’ve tried Exercise 1 and not reached a conclusion, then read through everything you’ve written down.

5. Put the piece of paper with your question on it under your pillow (seriously).

6. Go to sleep.

7. When you wake up in the morning, take the piece of paper out from the pillow and answer the question.

Your dreaming tonight is highly likely to be influenced by your referendum dilemma simply by virtue of it being an emotionally charged preoccupation. By directing this energy into a specific focus, and prompting yourself to contemplate it regularly, you’re seting up a temporary habit that stands a decent chance of repeating otself in your dreams.

Best case scenario, you wake with a resolution on how to vote. Possibly, you might wake up remembering a dream that is either obviously relevant (you dream about the referendum) or just feels relevant. Fortunately, I have already blogged about doing your own dreamwork, so for a bonus exercise, see: dream a little dream of me.

Alternatively, you may well work through both excercises, and find yourself still at an impasse on Thursday morning. In which case…

Exercise 3: trust the process.

You don’t have to know which way to vote until you’re in the polling booth, and even then you could just draw a massive penis on your voting paper or write Votey McVoteface in block capitals across the top instead. It’s a secret ballot, no one will know how or if you voted, and it’s the height of bad manners to demand to know how someone voted. If you’re ok with letting everyone else decide for you, then actually you don’t have a problem at all.

Maybe you’re stuck because, actually, you don’t want to vote. Did you ask for an EU Referendum? Did you want it? Probably not if you’re undecided at this point. It’s entirely possible that you’re caught in Sartre’s existential trap whereby the one choice you don’t have is not choosing. You didn’t ask to be born but you must decide what to do with your life now you have it. As with life, so with this referendum.

Maybe you’re stuck because you don’t think it makes much of a difference either way. And then people like me who favour one side over the other come along to tell you that absolutely everything depends on how you vote, and you start to doubt yourself. Well on the one hand, that’s democracy, so tough. On the other hand, forget us, we have no idea what’s going to happen either, not in the long run.

Ultimately, we’re making this decision because David Cameron decided an EU Referendum was the best way to answer the threat of UKIP and keep his backbenchers onside. It’s the worst possible reason to hold a referendum about anything, so if it all goes horribly wrong, it’s his responsibility, not yours.

Whatever’s going on for you, just roll with it. Don’t worry about being undecided, become curious about it instead. How often will the future of a continent rest on your shoulders? Surely that’s an experience worth savouring? Notice what you feel in your body. Notice what this decision means to you. Be as in these moments as you can be because right now is all there is and ever will be, and this particular right now will never be again.

And if after all of the above you’re still stuck, pencil in hand, and you don’t want to spoil your ballot paper? Toss a coin and enjoy the looks on everyone’s faces when you tell them that’s what you did.

Happy voting!

~ ~ ~

Image credit: photography by Istock, snaffled from www.gq-magazine.co.uk How you should vote in the EU Referendum.

Simple questions, complex therapy

The most elaborate of complexities can arise from the most elegant of simplicities. In gestalt, simplicity is achieved and maintained through a rigorous attention to the present moment, the legendary here and now.

Simple questions, complex therapy

Gestalt therapy can be stripped back to three basic questions:

1. What are you aware of now?
2. What do you need now?
3. What does this mean to you now?

Really, if you wanted to strip right back to bare bones, you could stick to question one. The entire body of gestalt therapy literature is essentially an elaboration on the question, “what are you aware of now?”. And arguably so is human experience, which is why the question works.

There is a cyclical flow to human experience, driven by awareness and organised by need. The function of these three questions is to explore this cyclical flow in the context of this person who is in therapy with me in this place at this time. It isn’t about diagnosing what is wrong with the person I am asking these questions. It’s about using these questions to explore the contact possibilities that exist between us.

The common by-products of this exploration are insight, realisation, and healing.

~~~

Photo credit: Simplicity (1/52) by Rodger Evans, licenced under Creative Commons

introjection visualised by jennydrewsomething

Shoulds: the internalised wants of other people

One of the arch-villains of gestalt therapy is the word “should”.

If you’re in therapy with a gestalt therapist, and you start talking about things you should be doing, chances are your therapist’s self-talk has started going, “holy shit! Introjection at twelve o’clock! Kill it! KILL IT WITH FIRE!”. This is because “should” is treated as a dog-whistle term for introjection, and if gestalt had a Wanted: Dead or Very Dead list, introjects would be towards the top.

Introjection is a hang-over from gestalt’s psychoanalytic heritage that hasn’t quite been deconstructed satisfactorily. Which is ironic, really, considering that that’s what introjection is all about. Essentially, introjection is the uncritical internalisation (metaphorically, swallowing whole) of the thoughts, opinions, rules etc of other people. Two main types of introjection can be identified: force-feeding (ie, I introject your rules because you force them down my throat), and inferences (ie, no one says anything directly, but I develop the impression that such and such is the case). The key factor is that I do not apply critical thought to (metaphorically, I don’t chew) what I take in.introjection visualised by jennydrewsomething

A key force in gestalt therapy is semantics. The words you and I use to communicate don’t just contain valuable information about the kind of people we are, they also shape the very experiences we are attempting to communicate. In day to day therapy, this translates into drawing someone’s attention to the words they are speaking. This then raises that person’s awareness of how they are creating their experience in the moment.

I find it instructive to replace “I should” with “x wants me to”. The word should is most usually used to invoke an external authority. What Gary Yontef calls shouldistic-regulation (ie, regulating oneself according to external authority) stands in direct opposition to organismic self-regulation (ie, regulating oneself according to organismic need). When someone says, “I should do better”, they nearly always mean, “x wants me to do better”, where x is a significant internalised other. Shouldistic-regulation is striving to do better because I should. Organismic self-regulation is striving to do better because that’s what I need to do at this time.

The same applies to societal norms and moral codes. “I should not steal”, is really, “x wants me to not steal”. This is obviously the case with regards to force-fed introjects; someone has to do the force-feeding. This is less obviously the case with inferences because, at first glance, no one is doing any force-feeding. The modification I would make in this case is, “I imagine x wants me to”. That is, the inference I am making derives from either the kind of social atmosphere I am experiencing, or the extension of pre-existing rules.

Social atmospheres “give me the impression” that such and such is and isn’t acceptable. But social atmospheres emerge out of the interactions of actual people, allowing me to identify who it is that I am imagining wants me to x. Pre-existing rules give me a way of anticipating what possible rules might apply to a new area of activity. As pre-existing rules are put in place by actual people, I am again able to identify who it is I am imagining wants me to x.

The therapeutic objective in this odd little game is grounding social constructs in actual people. Moral codes do not spontaneously come into being of their own accord; they are created and maintained by people. The kinds of introjects that become the focus of significant therapeutic effort generally need to be traced back to their origin. And that origin is frequently “my dad”, or “my mum”, or “God”.

A hugely important part of therapy is deconstructing the introjected rules by which a person is constrained. That process will invoke resistance from the internalised originator of those rules. And frankly, if I’m going to be up against someone’s internalisation of God, I’d rather know about it!

~ ~ ~

Image credit: jennydrewsomething.

british gestalt journal reviewed

Towards an evidence based gestalt therapy: the gestalt CORE project

The latest issue of The British Gestalt Journal features an article writing up the findings of the gestalt CORE project (hereafter Stevens et al). In their own words:

This is the account of a three-year research project within the Gestalt therapy community in the UK. It is an example of clinically-based, mostly quantitative research carried out in a methodical and rigorous way, using voluntary effort and minimum funding. The results can be compared with national databases of similar UK studies and show that Gestalt psychotherapists are as effective as therapists trained in other modalities working in the NHS and in primary care (p22).

The issue of evidence-based therapy is a thorny one in the UK, and one which places Stevens et al’s research into an interesting political category. I have a mixed reaction to these research findings, so offer that reaction here. I’ll conclude with congratulations to the people who put this research together because (and I apologise for this in advance) it was clearly a hardCORE effort.

NICE

Let’s start with NICE guidance, because it’s not always all that nice. NICE (or The National Institute for Health and Clinical Excellence to its friends) is a laudable organisation with laudable aims.

From its what we do page: “we develop evidence-based guidelines on the most effective ways to diagnose, treat and prevent disease and ill health”.

From its who we are page: “the National Institute for Health and Clinical Excellence (NICE) was set up in 1999 to reduce variation in the availability and quality of NHS treatments and care – the so called ‘postcode lottery’”.

So, NICE exists in order to ensure that someone in BS6 gets the same quality of treatment as someone in S13. This is basically a Good Thing; no one really wants to die or experience extended pain and suffering because their doctor didn’t get the memo. Which of course leads us to how we decide what is effective in any given case, which in turn leads us to evidence-based care. If I’m going to be prescribed medication, I want it to be the most demonstrably effective medication for my condition, not the only one my doctor knows about (or worse, the one whose company was more effective at marketing to my doctor).

This is all classic medical model stuff. The human body is this really cool machine, and when it breaks or malfunctions, you just identify the faulty part(s) and fix it/them. Since the introduction of that model, infant mortality rates have dropped, diseases that used to be deadly are now fairly routine, and heart transplants are possible. I don’t think anyone really wants to throw out this particular baby.

The bath water, however, is another story. While the medical model allows for miracles when applied to physical conditions, it frequently stalls when applied to issues generally related to the experience of being human. The very idea of mental illness is itself a logical fallacy that presupposes a genuine separation between mind and body. And that leads us into problems because, having presupposed the existence of a distinct ‘part’ called the mind, the medical model then attempts to identify the part of the mind that is malfunctioning in order to fix it. Hence the rise of psychopharmacology and the fallacy of the chemical imbalance model of mental illness.

The conclusion of all this is that, when presented with people whose suffering has more to do with the experience of being human rather than their human machinery, NICE continues to assume it is essentially dealing with a machine and seeks standardisation. And that standardisation requires an evidence-base that strips away the humanity of the individual in order to discover the essential underlying problem. Which simply isn’t possible when there is no essential underlying problem; the so-called malfunction is itself an expression of the humanity of the individual.

And this leaves a major problem for gestalt, because the NHS is the main provider of ‘mental health’ services, and its IAPT (improving access to psychological therapies) programme follows NICE guidance. And NICE guidance strongly favours CBT for treating mental health problems because, as Stevens et al acknowledge, it has a bigger evidence base:

CBT has had the most exposure to clinical trials since it uses set protocols which enable standardised collection of quantifiable data (p22).

Given why NICE has been established, this is understandable. From the perspective of the medical model, clinical trials establish efficacy of method, and set protocols allow for standardisation. Try establishing a protocol for ‘sitting with the uncertainty’ or ‘intuiting my client’s desensitisation on the basis of changes in my own bodily experience’. Quite.

So that’s my meander into NICE and evidence-based therapy. What I’m establishing here is the political ground against which Stevens et al’s research needs to be taken: the therapeutic hegemony of CBT.

Research findings, self-validation, and the equivalence paradox

The key finding of this research is that gestalt psychotherapists are shown to be as effective as other types of psychotherapist according to CORE data. Stevens et al used three other studies with which to compare results. I’m not entirely clear why these three particular studies were used or which other studies were passed over for inclusion, so I think the article would have benefited from a literature review. The result of the comparison is that two studies with large datasets provide benchmarking material, whilst the third study focused on minimally trained mental health counsellors.

My response to these results has been interesting. I was angry at first, in the ‘well tell me something I don’t know and this is just political maneuvering not real research’ vein that is the clearest sign one of my buttons has been pressed; the animal anger of being prodded somewhere sore. A bit of licking later and I realise I am relieved. As a therapist, I sit with a great deal of doubt. I doubt that I’m effective. I doubt that gestalt is effective. I doubt that psychotherapy is effective. After all, if it’s all essentially placebo, then I’ve spent a lot of money, time and energy training in the interpersonal equivalent of prescribing sugar pills. My anger was masking a more fundamental feeling of ‘thank fuck for that!’. There is something vindicating about seeing quantitative research with headline numbers that appear to prove what I do is effective.

Now, pursuing that need for external validation appears highly antithetical to the gestalt therapy that Perls et al originally set down, and I think that will make this research controversial within the gestalt community. On the one hand, I practice a therapy that emphasises organismic self-regulation and the importance of self-validation over living up to externally imposed standards. On the other hand, the rise of CBT as the NICE approved therapy of choice is a genuine social challenge that I want to make contact with, not avoid. As Stevens et al point out:

If as Gestalt therapists we do not take seriously the challenge to articulate and evaluate our therapeutic claims we may be left talking only amongst ourselves and limited to working only with those clients who can afford to pay privately (p26).

I have introjected gestalt therapy if I use the ‘but Perls said I should discern things for myself and not be concerned with empirical validation’ line of defence to block contact with a genuine social challenge. If need organises the organism/environment field, then the fact that standardisation and evidence-based practice is organising the field of psychotherapy provision demonstrates the operation of powerful needs. Furthermore, if many gestalt therapists are, like me, not trained in quantitative research methods and don’t have backgrounds in academic psychology, then we are in danger of not contacting the woods for our own projected trees.

All of which serves to focus me on the CORE methodology and what Stevens et al identify as the equivalence paradox: “treatments that have different and incompatible theoretical backgrounds, philosophies and techniques tend to have the same degree of success as measured by CORE” (p24). In addition, the study focusing on minimally trained practitioners showed what I would have hypothesised; that minimally trained practitioners were less effective than professional practitioners.

This equivalence paradox speaks to an intuition in me that for all our different approaches to doing therapy, as practitioners we are all essentially undertaking the same journey only with different preferred routes and ways of travel. Psychotherapy theory seems to have more to do with the preferences of the therapist than it does the effectiveness of the therapy itself. Which is incredibly ironic because it means that, in the arena of working with the human experience, diversity of method actually leads to standardisation of efficacy!

On the other hand, maybe the equivalence paradox is actually an inherent flaw in CORE methodology itself. Perhaps the statistics are simply recording client expectation of what should be the case rather than effectively measuring what actually is the case. A key question there would be whether the clients in the minimally trained practitioner study knew that their therapists were minimally trained and adapted their expectations accordingly.

Politics and dialogue

Where I seem to end up with all this is a sense that Stevens et al have provided gestalt practitioners in the UK with a valuable opportunity to take part in a national conversation. That makes this research political as it has more to do with positioning gestalt in the professional field than it does developing gestalt practice. Both are valid reasons for research.

Ultimately, politics is an opportunity for dialogue about how key collective issues are to be addressed. And dialogue, as I am keenly aware as a gestalt practitioner, necessitates a willingness to open to contact with an other in such a way that risks being forever changed by the process.

And by definition that works both ways. Stevens et al used the CORE methodology not because it is finely attuned to the needs of gestalt practitioners; the writers acknowledge that there is no gestalt therapy box on the forms that need to be filled in (p23) and that filling out forms every session is quite alien to gestalt’s relational approach (p26).

Rather, the CORE methodology was used because it is a well-established outcome measure that allows for comparison with many other studies, including CBT (p22). In therapeutic terms, Stevens et al decided to learn and use the language of the people they are trying to reach rather than impose their own. Once gestalt therapy as a profession is part of that ongoing conversation, we can then also deconstruct introjections about what should count as an evidence-base and better dispel projections about gestalt therapy as an approach.

Finally, what this also highlights for me is the politics of research as an activity in itself. Having conducted my own, qualitative research, I’ve needed to address the issue of researcher bias and the various political and philosophical assumptions that underlie research as an activity. Basically, who asks what questions and why?

With respect to the gestalt CORE project, the GPTI (Gestalt Psychotherapy and Training Institute) discussion list was the birth place of the CORE project, growing out of “gestalt therapists’ concern to find a way to research the effectiveness of their work” (p22). GPTI also funded costs associated with CORE software and training for the first year to get the project started. Gestalt therapists volunteered to take part in data collection, and The British Gestalt Journal hosted a recruitment page with information about the project and downloadable forms.

One way of looking at this research, then, is this: a group of gestalt therapists, with funding from a gestalt therapy organisation and assistance from a gestalt therapy journal, have conducted research whose findings claim gestalt therapy is as effective as other therapies. This appears to justify one of Babette Rothschild’s favourite phrases: outcome focused research is some of the most biased research there is.

I think this bias is real and would hopefully be recognised by Stevens et al. However, I don’t think that recognition of vested interests damages the research. Rather, I think it opens up nicely the same question of vested interests for outcome focused research in general, and CORE studies in particular. After all, “the CORE measurement is primarily designed to provide managers and practitioners with evidence of service quality and effectiveness” (p23). The whole point is to demonstrate the level of effectiveness, not falsify.

Consequently, the inevitable criticism that can be levied at Stevens et al (ie your research is biased by the vested interests of those concerned) applies equally to other studies and only serves to demonstrate the impossibility of the neutral researcher; the motivation to research has to come from somewhere.

Congratulatory note

What I hope this post portrays is my attempt to reconcile my own thoughts and feelings about the possibility of evidence-based therapeutic practice with my recognition that this is an important piece of research for gestalt therapy.

My congratulations go out to Christine Stevens, Jane Stringfellow, Katy Wakelin, and Judith Waring for putting together this research. This was research conducted by volunteers, outside of academia, and with minimal funding. That is in contrast to CBT as an approach, which has an easier time gathering an evidence-base precisely because there is a greater abundance of resource aimed at producing that evidence-base.

In conclusion, I think those involved can consider this to be three years well spent, and I’ve enjoyed the challenge of chewing over this research.

Article reference:

Stevens et al (2011) The UK Gestalt psychotherapy CORE research project: the findings; The British Gestalt Journal, Vol. 20 (2), pp22-27 (online ref)

dream a little dream of me

Dream a little dream of me

I’ve been quiet on the blogging front of late. This is because I’ve been directing most of my spare time and energy into a research project exploring the gestalt approach to working with dreams. Not only am I fascinated with the subject matter but I’ve also become somewhat entranced by the research process itself. Lots of material for future blog posts I’m sure!

In the meantime, I’d like to give an introduction to the gestalt approach to dreams, as it strikes me as an approach that warrants more attention and exploration.

Essentially, the gestalt approach to dreams is to become and experience as much of the dream content as possible. This is in contrast to an analytic approach in which the dream’s meaning is interpreted; either as your way of symbolically coding what you know to be true but want to avoid knowing (Freudian tradition), or as your way of manifesting collective archetypal forces (Jungian tradition).

Classic gestalt dreamwork involves telling your dream in the first person, present tense as if you’re back in the dream and it’s happening right now. That re-activates much of the energy tied up in the dream. The rough methodology of dreamwork involves choosing parts of the dream that attract your attention and ‘becoming’ them.

If I’m sat at a desk in my dream, then I can speak as me, or I can speak as the desk. I can become aware of other characters and objects in the dream and speak as them. As I do this, I notice what I become aware of and feel as I speak from the desk part of myself. Spontaneously, I might make new connections, reach new insights, or connect with feelings that I usually stop myself from connecting with.

By focusing on the here and now of dream exploration, gestalt shifts the focus from finding some meaning for the dream, to making contact with whatever is tied up in the dream. We don’t need to answer the question ‘What does this dream mean?’. One dream can answer a dozen different questions at a dozen different times, the only real relevance test being does the dream seem in some way relevant to you now?

And like anything in gestalt, you can self-verify this through experimentation:

Phase 1 Recall your dream. If you can, speak it out loud; if not, think it through or write it down. Stay in the first person, present tense (eg ‘I am walking down the road and notice a squirrel up ahead’). Notice what you become aware of as you recall your dream.

Phase 2 When you’ve finished recalling, choose something from the dream that you’d like to play the part of for a while. To start with, it helps if you switch seats to become this dream aspect. Now, speak from that dream aspect and explore your perspective in the dream (eg ‘I am a squirrel and I’m standing here in the road and…’). Explore what you’re thinking, how you feel, what you’re aware of (eg ‘I am a squirrel and I’m thinking….’, ‘I am a squirrel and I’m feeling….’, ‘I am a squirrel and I’m aware of…..’).

Phase 3 Create a dialogue between you as you, and you as the dream aspect. Keep one seat for you, one seat for the dream aspect, and change seats to speak as each part. Having spoken as the dream aspect, what would you like to say to it? Is there anything you’d like to ask it? So, I ask the squirrel ‘what are you doing in the road?’. When I change positions and become the squirrel, I answer ‘I’m giving you an amusing example to use in your blog’. The idea is to suspend your expectations and go with whatever comes up until you feel you’ve reached a natural conclusion. You can then repeat phases 2 and 3 for as many other parts of the dream as you want.

What’s key in the three phases above is that the exploration takes place in the immediacy of felt experience, and allows meaning to arise spontaneously out of creative exploration. Everything in your dream is taken to be some aspect of yourself, and so you’re invited to re-absorb some of those energies and perspectives.

This is the approach that came to characterise gestalt dreamwork, and is heavily influenced by the charismatic example of Fritz Perls. What’s especially interesting for me is the theory that sits behind this way of working. Essentially, the methodology above rests on the idea that dreams are projections of the dreamer. That is, everything in the dream is some aspect of self that has been dis-owned and which the self is attempting to get rid of.

Projection is pretty much like trying to throw a part of yourself away. You can’t throw parts of your selfaway though, so they instead become experienced as something external to yourself. Working with projection is a matter of re-owning projected aspects of self. This is why Perls described dreams as ‘the royal road to integration’; by re-owning aspects of the dream, I am re-owning aspects of my self and so moving towards greater self-integration.

Of course, this way of working with dreams doesn’t fly with everyone; not everyone is entirely comfortable about dialoguing with their inner squirrel. And that’s fine; the above is just one way of working with dreams in gestalt, and I generally adapt my method according to what’s appropriate for the given situation. My research interest is in what happens if gestalt therapists work with dreams in a deliberately different way that emphasises different gestalt concepts.

That’s proving to be a very interesting voyage of discovery for me. And if I give my voyage a voice and ask myself where I’m taking me? I just laugh and tell myself to wait and see!

~ ~ ~

Image credit: www.theodysseyonline.com: On the Importance of Dreams.

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