Gestalt Against Depression First part

Link and Integrative Process

By: Jesus Miguel Martínez - Doctor, Psychiatrist by the Central University of Venezuela.Especialista Dynamics

and Group Psychotherapy for the Institute of Cultural Affaires

CENTURY EPIDEMIC

"... It's like being stuck in a tunnel or a dense forest. Solo. No hopes to get out

someday ... rather thinking it can not get out ... or with the conviction that there is no

output whatsoever, and the absolute assurance that no one can help you. There comes

a time when no longer afraid, no longer causes that keep fighting. You only want to

die and not have the strength to kill you, you just have to want it. "

Thus a patient I described his dramatic experience with this disease that progressively

threat to become one of the worst evils of this century. Depression has been gaining

monstrous dimensions across the world.

Just to give an idea of what previously asserted, I will mention that in 1996 the World

Health Organization (WHO) has hired a team of independent researchers led by Dr.

Dean Jamison, professor of Public Health at the University of California, in Los

Angeles, for a prospective study to identify the major public health problems by

2020. The committee that conducted this study used a measure that emphasizes not

only mortality but also in the quality of life and loss Of the health: "Disease burden

measured in years of life adjusted for disability" (DALY: disability-adjusted life

year), ie the sum of years of potential life lost due to premature mortality and the

years of productive life lost due disability caused by the disease.

In preliminary measurements it determined that by 1990 the main pathologies that

plunged to the individual to a disability affecting the welfare and everyday

performance and killed prematurely, were lower respiratory infections, diarrheal

diseases, perinatal pathological conditions , unipolar major depression, which by that

time occupied the fourth place, ischemic heart disease, cerebrovascular diseases,

tuberculosis, measles, trauma caused by traffic accidents and certain types of

congenital abnormalities.

Projections made by the team of Jamison 2020 indicated that depression threatened to

increase making it the second leading cause of disability worldwide. When the

projections were reviewed by gender, it was determined that to this date the

depression threatened to become the leading cause of disability in women in

developed countries and also the first in the third world countries, above accidents

transit, coronary disease, chronic obstructive lung disease, of cerebrovascular

accidents, tuberculosis, respiratory infections, the consequences of wars, AIDS and

diarrheal diseases were occupying the remaining nine places the list of the ten threats

to the third world.

It is easy to understand why some experts have called depression epidemic century.

According to figures published by the Pan American Health Organization (PAHO) in

September 2001, it is estimated that there are around 25 million people with

depression in Latin America and that could reach 35 million by 2010. Only 15

percent They are diagnosed and receive appropriate treatment.

HELPING THE DEPRESSED: What works?

The role of psychotherapy in the treatment of this disorder is of fundamental

importance. There are three basic ways to approach the treatment of depression. The

first is pharmacological, ie prescribed to patients afflicted by any of the many

antidepressant drugs sold in the market disorder. The second is the application of

certain characteristics of any of the methods of psychotherapy tools, the third is a

combination of the above strategies.

The drug has an important advantage: it is faster, with a good drug treatment

depression symptoms disappear, or at least improve dramatically in an average time

not exceeding four weeks and is sometimes reduced to only a few days, However,

drug treatment is mostly symptomatic, meaning that very often when removing

antidepressants depression symptoms reappear after a few months, the patient

experienced a relapse; They are also more frequent recurrences, the drug does not

prevent the patient sick again from the same box. In psychotherapeutic treatment

relapses are much less frequent and relapses, but the onset of improvement is much

slower than with treatment with antidepressants. Numerous studies indicate that when

both strategies are combined prevail advantages of both, ie with combination therapy

patients are disappearing faster symptoms of depression and are less likely to relapse

or recur when the medication is discontinued.

Psychotherapy has the ability to further improvement of this disorder, which makes

this durable over time and cause changes in the person and his way of approaching

events of their environment, this desminuye notably the possibility of re- sick of a

depressive disorder. But are all effective psychotherapies? Which of the

psychotherapeutic models is most appropriate for the treatment of depression?

There are moments for different theoretical trends about depression and each offers a

particular approach to some aspects in common and some differences. I'll make a

brief mention of which have been considered most relevant.

The best known of these is undoubtedly the psychoanalytic theory that depression

treated as a return aggression towards me in an internalized object that has an

ambivalent subject to the significance of love and hate lies. Based on this view

psychoanalysis explores memory last patient seeking the cause that generates

ambivalence and self-injury, also seeks to strengthen the self that can resist

aggressive impulses of the superego. .

Cognitive therapy, developed by Aaron Beck model and has placed great emphasis on

the experimental demonstration of the results, suggests that depression is a cognitive

distortion, in which the patient suffers as a result of an experience of loss sustained in

a time of patient's life that this could not work it properly. This event causes a change

in the self-evaluation of the subject, the way it interprets its environment and

assessing their ability to manage in the future (aspects Beck called cognitive triad). In

a person high and rigid targets set failures in achieving such objectives are understood

as a profound and unsurpassed themselves default, this will add a feeling of deep

sadness and acute and relentless self-criticism which are characteristic of depression.

Beck argues that depression is an emotional but no cognitive impairment.

Seligman (1974) he proposed another way of understanding depression, according to

which this was caused by a feeling of inadequacy learned [1] , in which the patient is

perceived incompetent to avoid situations of suffering or to control and promote those

that produce gratification and therefore it blames himself. This proposal is known as

the theory of learned helplessness.

From the standpoint of behavioral theory Ferster, Lazarus and Lewinshon, they

raised that depression was the result of a three reinforcement behavioral phenomena:

first, insufficient reinforcement of some behaviors that foster satisfaction and

increase the likelihood of achieving specific goals, second the limited availability of

adequate backup environment and ultimately the loss of effectiveness of

reinforcements available.

Mathews depression considered as a failure of self-regulation that occurs when a

sequence of behavior does not get adequate success in a specific situation, then

individuals spend on phased self-review, self-assessment and self-reinforcing.

Depressed subjects, for certain reasons Mathews insufficiently clear, have a

predisposition to be evaluated as inflexible and thus make autorrefuerzos inadequate

so that spontaneous self-regulation of the subject is lost.

The inefficiency in the establishment of certain relationships was adduced

by Salzman Y Coyne who claimed that depression was because people felt they

had lost the esteem and affection of some very important figures in their environment.

These perfectionists and rigid subjects resorted to a series of mechanisms of coercion

as the request, the despotic demands, manipulation or emotional blackmail to force

people to reintegrate significant affection that they assumed lost.

Finally I will mention the approach of Benton who claimed that depression was both

an attempt to protect the patient from threatening or traumatic experiences as a

mechanism to re-experience the loss to resolve.

When a thorough study is found that all these theories have in common with the

approach that makes the Gestalt psychotherapy around depression. For example, the

interaction between the rigid superego and threatening and some aspects of self that

proposes psychoanalysis in some ways resembles the polarized relationship "top dog"

and "Underdog" posed by Perls. The notion of unfinished gestalt raises similar to

those reported by Beck when talking about the traumatic event of loss not elaborate

mechanisms, a situation that was also proposed by Benton and behavioral authors.

And needless to mention how close you are Gestalt psychotherapy approaches made

by Mathews as the concept of self-regulation bill Organismic is Gestalt. However,

despite the obvious conceptual coincidences about the etiological origin of depression

we have with them many divergent points that will be presented later in this paper.

The most important thing is to note that there are different perspectives on the origin

of depression, many of these approaches have succeeded in reducing depression, but

they have gained greater effectiveness are those that include correcting cognitive

distortions, modification patterns of social interaction and the experiencing and / or

expression of emotions. Gestalt therapists can say that the integration of the

personality, which is the ultimate goal of Gestalt therapy, amply covers all these

components, and this is precisely why the effectiveness of this model on mood

disorders among them Depression is in its various manifestations.

DEPRESSION FROM THE POINT OF VIEW GESTALT

From a Gestalt perspective depression is seen as the product of a conflict between

two segments of the personality that have been disrupted and these two polarized

components of personality were called by Perls as "top dog" and "Underdog."

Actually these two components are a set of introjects and beliefs that have been

incorporated by the patient probably since childhood and which by their nature and

come from people who have a great influence on him, such as his parents or who

made the sometimes they have been incorporated into the personality unchallenged at

any time.

The top dog is a series of elements that constitute a severe consciousness coming

from the outside that was internalized and now part of the patient's personality, these

elements were introjected under the pressure of emotions such as guilt, shame and

fear of being be severely punished or abandoned emotionally and have the function of

caring for the person to do and think "right," "what to" severely punish and make a

self-criticism as a transgression of these rigid standards, is a kind of police punitive.

Meanwhile the dog below embodies a set of attitudes and beliefs used to manipulate

others and they do see the patient as a helpless, inadequate and incompetent to be in

need of compassion and protection of others and constantly receives attacks Dog

above.

Unconsciously the depressed patient splits his personality in these two segments that

show what the person wants to do and what you think you should do, manipulative

embody the victim and the victimizer punitive. The depressed patient breaks contact

with certain elements or people or environment field, with some aspects of himself or

some of the emotions you feel. The way to interrupt this contact is through specific

manipulations. Manipulates people and himself intoned projecting other polarities top

dog and the underdog, the projection does not allow the feeling and expression of

emotions that these parties disintegrated personality will generate so the gestalt It

never ends and the conflict remains unresolved.

Field-Environment Agency

The conception of man's own Gestalt psychotherapy suggests that humans, like all

living organisms are inextricably linked to the environment in which they live and

develop. As suggested by the French Gestalt Jean-Marie Robine we can not refer to

the man without reference to the air you breathe or the gravity that holds together the

ground, or an angry person without being implicitly referring to the obstacles in its

path.

Humans then we body-intone fields, units of influence and permanent transformation

linked interdependently the environment in which origin is given to certain types of

experiences from meeting basic needs to complex brain functions such as learning the

mind, the self, health and disease. On the border of contact between the organism and

its environment the process of organismic self-regulation occurs, whether this occurs

in an efficient manner the subject gives satisfaction to your needs, complete its

Gestalt, if the organismic self-regulation is interrupted by the appearance of some of

the contact resistance mechanisms will take place different diseases, including

depression.

This notion of human beings as a field has its origins in the work of psychologist Kurt

Lewin who develop field theory from the theories of physicists Michael Faraday and

James Maxwell who described the behavior of electromagnetic fields. Lewin found

useful aspects of this physical theory to describe the behavior of human beings in

relation to their environment.

Depression occurs for an interruption or blockage of organismic self-regulation in the

limit contact between the organism and its environment which are part of a unified

field of mutual influence.

Depression in Cycle SRO-Organismic

To understand the dynamics by which it appears, is expressed and depression is

treated according to the Gestalt model is necessary to refer to the cycle of organismic

self-regulation. It is a sequence of events that occur when the individual attempts to

satisfy their needs or desires. Gestalt psychotherapy studies and contact addresses,

that is, the complex relationships that occur on the border between the organism and

its environment, all contact is a process of organismic self-regulation, that is, an

adjustment between organism and environment. In this process the experience is the

process done in the field and the field is created, and then removed from contact with

the border that unites and separates the organism and its environment.

The head of the experience is the excitation energy. The excitement makes the

experience flowing through the cycle of self-regulation. This flow may be hampered

by bygone events or present life of the individual which generate emotions and carry

blockages in the flow of excitation through experience cycle. Some of these blocks

that disrupt the contact are responsible for depression.

The way humans tend to meet your needs from the simplest as a physiological need

to complex, a desire, an attraction, an instinct, an emotion or an unfinished situation

requires an energy we call excitement mobilizes through a series of steps in the cycle

of self-regulation. I will use as an example the resolution of a physiological need as

thirst and you know that this can it happen with the satisfaction of sexual desire, with

the treatment of a phobia of heights, developing a grieving the loss of a loved one or

the emergence and treatment of depression, of course each with its peculiarities and

complexities. A person at rest or perhaps engaged in other activities like reading a

book or having a business conversation perceived as a need arises, initially it's just a

confused, vague, vague feeling but it attracts attention and disturbed rest or other

activity, that is the stage of feeling.

Like: Surge, gradually or suddenly emerges a figure that stands out from the

undifferentiated background. This figure can be a periodic pulse requiring satisfaction

of a part of the environment as hunger or thirst sexual desire; or perhaps a non-

periodic stress related more to the body internally as a digestive upset or a toothache;

also an emotional need as love or disorders caused by changes in the environment as

lost or affective labor problems, perhaps physiological adjustments in response to

changes in the organism-environment field ranging from temperature variations to the

recovery of a cerebrovascular accident vascular.

The feeling becomes more precise and definite and is identified by the individual

stage entirely realize how thirsty, then it is recognized as a body belonging to own

need.

Realize: The picture that emerges becomes the focal point of interest in the

individual's conscious experience in the here and now. It is characterized by an

intense sensory, volitional, behavioral, emotional and cognitive experience and a

strong sense of belonging, is no longer a desire, feeling or need, it is my desire, my

feeling or my need.

This need and disturbance generated differ in the subject an amount of excitement

that will be aimed at meeting the need, is the stage of mobilization of energy, in

which the subject defines strategy and mobilizes volitional elements that need to meet

the thirst.

Energy mobilization: Active self excitation resources, the needs are completely

defined generated images will energy and possibilities of satisfaction, the motor

system is activated and senses open to information on the environment in search of

the possibilities in this to satisfy the desires or needs

The mobilized energy is transformed into action, environmental resources that are

considered adequate to meet the need and the subject moves into them are selected.

At this time the subject gets up and heads for the nearest source of drinking water.

Action: To choose and implement appropriate action, perceptual, behavioral and

emotional activity is organized, the obstacles are evaluated and the action that must

be responsible for resolving the tension generated by the need is undertaken.

The Agency contacts with elements of the chosen field as adequate to satisfy the

need, thirst in this example, then take the water poured into the glass and swallowed

Contact: Our sensory and motor functions facilitate contact with environmental

elements of the field whether these objects or people, or personal items such as field

memories, images or other aspects of self to meet the need. All contact occurs at the

boundary between the self and the environment.

After the final phase of the contact contact occurs, when the subject appropriates or

field elements that satisfy the specific need, water is assimilated satisfying thirst.

Final touch: A part of the environment has been incorporated into self with both the

self and the environment are transformed to generate a momentary disruption in the

organism-environment field is modified. For a moment the figure becomes the only

gestalt in existence, joins perception, movement and emotion experience intensely

expressed in the body either satisfaction, joy, sadness or sexual climax.

Then the stage of satisfaction that the subject is clear of the field with the embedded

element and assimilates the experience occurs. Thirst is gone.

Satisfaction: Characterized by a sense of satisfaction and relief at the disappearance

of stress, reflection on the importance of the implemented resources, learning and

assimilation of experience. The excitement comes to an end and the figure is

weakened. Intone self and now have a new configuration have been changed.

The subject content is removed again enters the resting stage or fertile vacuum

pending the next need.

Between each of these steps in the sequence blockages caused by different

mechanisms of resistance as mentioned some may lead to the occurrence of a

depressive disorders can occur.

Observation and clinical experience have shown us that different mental pathologies

disrupt or impede the flow of excitation or energy through organismic self-regulation

cycle (also known as cycle or cycle gestalt experience). Several authors have tried to

find a clear correlation between the specific point in the cycle in which the flow of

excitation is interrupted and various diseases and even more between the diseases and

the mechanism by which the interrupt occurs, has also been tried, linking

mechanisms of resistance to particular times of the cycle of self-regulation. These

attempts have some few coincidences and numerous disagreements. But what is

phenomenologically evident is that there is a relationship between interruptions and

pathologies, from a clinical point of view, it has been amply demonstrated that the

techniques that restore the flow of energy through the cycle and helping the patient

eliminate contact resistance mechanisms associated with the interruption produce

improvement or disappearance of the pathological picture transient or permanent. The

clinical picture is also related to the resistance mechanism used to promote the

interruption.

Severe depression, according to the hypothesis of agreement should consist of a break

between the withdrawal and the new sensation through the mechanism of repression

or energy between mobilization and action through retroflection. However, the reality

is more complex and less ideal than these authors has glimpsed. As pointed out by the

French Gestalt Anne and Serge Ginger and British Petruska Clarkson, experience

reveals that most of the mechanisms of avoidance (introjection, projection,

retroflexion, confluence, etc.) usually occur at different times of the cycle of

organismic self-regulation. And it has also become apparent that a condition can be

determined by various resistance mechanisms that exert their effect at various times

in the cycle.

Depression can be so deep that the subject hampered their ability to have experiences

of himself and the environment, is isolated in his bed, he sleeps hold and lose the

ability to feel pleasure in things you once liked them, even to not perceive hunger

signals your body sends you; in this situation the avoidance or resistance mechanism

is known as desensitization interrupting the feeling that this is the first step of the

cycle of self-regulation. At other times the deflection mechanism through which

direct contact with their own experiences or the environment interrupts the full

realization, the patient can then say phrases like "okay I was orphaned, but it actually

prevents it orphan're born alone and always alone "thus does not establish a full

contact with the pain of loss but is able to perceive his presence.

Other patients achieve adequate notice of the loss and pain that this causes, but are

unable to mobilize their energies to establish contact with environmental resources in

these situations is common that some beliefs introjected prevent the mobilization of

energy or contact with the environment is needed for the resolution of the gestalt,

they were heard saying "... if it really hurts that has left me but I will not talk to her to

fix anything, if humbled me worse." The contact can also be interrupted by

retroflexion of emotions such as anger, then the patient begins to make himself what

he would do to others and initiates a series of autorecriminaciones and even

physically attack each other in various ways. It looks like depression may be

mediated by disruption of the cycle of experience at different times and by different

avoidance mechanisms.

DISTINCTIVE ASPECTS OF GESTALT

General features

The gestalt psychotherapy has some features that differentiate it from other

psychotherapeutic models and in which much of its effectiveness lies. There are

certain fundamental aspects that together make it very different from other models.

First you are given much more importance to the phenomenological experience of

subjective experience, that is what the patient experiences in a given situation and as

experienced; in the psychotherapeutic context it is emphasized bodily sensations,

gestures, postures, facial features, blush, involuntary trembling, etcetera. The verbal

speech and intellectual understanding, but are also considered to have a less

prominent place to the feelings, emotions and how these are manifested; We

understand that experience is the main way of learning and change.

The second aspect is to work in present time, with the patient's experience in the

"here and now". This does not mean that the relevance of past declines in the genesis

of diseases or trends patient to act in one way or another to their conflicts; it is

considered that past events like souvenirs or any unfinished business and future

situation as a fear or expectation, affect the present moment the subject generating

emotions, thoughts or volitions which have to be addressed in its current meaning in

the current therapeutic process.

The gestalt psychotherapy takes man holistically, as an integrated unit, we see no

difference between psyche and soma, between mind and body. The human being is

inserted to their environment in close and interrelated way, so do not think that the

distinction between diseases of the mind and the body has diseases meaningless, like

the distinction between organic and functional disorders or endogenous and

exogenous depressions . These distinctions are supported by a narrow view, restricted

by theoretical dogmas or lack of information from the limitations of the diagnostic

methods. The human being is unbalanced, it disrupts globally, as a whole, where

what happens emotionally affects the body and vice versa.

Living beings are self-regulatory organizations in the homeostasis plays an endless

series of actions to stop bleeding from a wound, to develop emotional grieving a loss.

The psychological mechanism of homeostasis is known as organismic self Gestalt

psychotherapy. This is for all living things tend to bond with your environment more

harmonious way that is permitted, he performs with his environment a creative

adjustment that leads to give you the best satisfy their needs. In this conception as

symptoms and disease entities they can not be considered only as failed attempts at

self-regulation, or what is the same maladaptive to interact with the environment to

meet their wants and needs forms. It follows that the therapeutic job is not to fight

disorders or remove disease, but to help patients increase their resources and potential

to find themselves the path towards freedom, self-determination and health.

Gestalt psychotherapy as was raised by Yontef It is an existential dialogical

relationship based on the particular form of communication that characterizes the

gestalt dialogue and backed by the statements of Buber's I-Thou relationship. This

relationship model argues that there are several people (patients and therapist) that are

equally important and different functions in the therapeutic situation, and that both

are responsible for developing the process and generating the new experience of

reality that has come to call health.

And finally in psychotherapy gestalt great importance is given to the patient's body,

the body expresses emotions, conveys important information about the individual

personality and its disorders and is also an important vehicle for the integration of

dispersed aspects of personality.

On the Nature of Emotions

Mentioned under the previous title has the consequence that the Gestalt have a

particular way of understanding emotions. In classical psychological literature on

emotions he has dominated a focus on the grief and sadness that has made a huge

emphasis on loss and significant in explaining the emergence of feelings of sadness

and mourning separations. However, separations and losses are part of the daily

experience of everyone, every day we experience losses and in many situations

without realizing it.

The aging, the growth of our children, the development of our relationships makes us

go from one stage to another losing much of what is related to the previous one, job

changes, academics, family and the crowd and changes occurring in our environment.

They represent a number of missed, gestalts that are destroyed to make room for the

formation of others. Any change means the destruction of our organism-environment

field to allow the formation of a different giving us the opportunity to evolve and

perfect. We got married, broke up, our children are born and then grow up and move,

change jobs, move our friends and make new friends, get older, our parents die and

nothing to change.

Sadness is an inherent excitement to the occurrence of are lost and these

transcendental or daily, meaning that sadness is inherent to the occurrence of

changes, the process of formation and destruction of gestalts. When not welcome

moments of grief and sorrow when a habit becomes evade, retroflection mechanism

leading to depression rather than the physiological duel starts.

We live in a hedonistic society that favors triumphant initiation and disqualifies lost.

Many people feel ashamed of situations that are natural to human existence.

Retirement, aging, divorce, the departure of the children, menopause, failures, and so

they are no longer opportunities to learn or passages of a life to another state and have

become sources of shame that people want to hide. When the formation of gestalts on

the destruction of these is privileged, you live in the future without assuming the

present or the past complete. People fail to complete their getalts evasively. The result

is the accumulation of unfinished end. And the inconclusive end inevitably lead to

distorted early neurosis that fill the existence of these subjects.

Some important conclusions are to be stated about the nature of emotions to properly

orient the work of depressive in the light of the knowledge of Gestalt psychotherapy

disorders. First. Emotions are neither positive nor negative or destructive, neither

good nor bad as so widely held; Most of our emotions are part of the genetics that

come into the world and are at the service of the survival mechanisms in this regard

are useful, which can be rated as good or bad is what we do with them, but these our

actions are not our emotions.

Secondly emotions have purpose and meaning, they are useful for something, anger

prepares our body to fight; Fear triggers a series of physiological mechanisms that

facilitate a quick escape; love is responsible for that emotional ties are established to

ensure the survival of the offspring and sadness provides the repetitive thought and

contemplation enough to reflect on the causes that originated and pretty causing

discomfort to learn to do something useful with such reflections; emotions arise in us

as an effect to events in the environment, an effect that generates a series of faster

than thought itself, in circumstances where reflection can be slow and

counterproductive behaviors; when humanists say that man is wiser than the intellect,

there is concern that the choices we need to handle more information than what gives

us our conscious part, is where the emotions, when, how involved and who we fled,

who attack or who we fall in love, they are not conscious decisions that are actively

involved in emotions.

Moreover, it is important to remember that emotions can not be controlled or

suppressed, control or suppress what is consciousness or expression of emotion;

control of emotional expression is a form of disruption in the cycle of experience and

a way to not take responsibility for certain actions. A very important aspect of Gestalt

psychotherapy is that people can turn to express their emotions in a constructive way

and this is the most suitable to do with them as catharsis does not eliminate or drains

emotion.

Gestalt Against Depression Second part

Link and Integrative Process

By: Jesus Miguel Martínez - Doctor, Psychiatrist by the Central University of Venezuela.Especialista Dynamics

and Group Psychotherapy for the Institute of Cultural Affaires

THE PURPOSE OF DEPRESSION

Mentioned in the previous section what is the purpose of sadness, now I'll do the

same in relation to depression by the clarification that there is the same phenomenon.

Sadness is a healthy, functional emotion while depression is sadness dysfunctional

and its purpose is far from help or protect us but the reality is that it has that intention.

Depression as a way to manipulate relationships. Depression often, in many cases, be

an attempt to manage relations with interpersonal issues that are significant to the

patient. Usually with close relatives. With its symptoms the person has obtained

power over the family, makes everything revolves around your depression, you get

the centrality and relevance that may have lost or can not otherwise obtain. Another

common dynamics in a family member is depressed to prevent somebody else to

collapse, leading to a strong position because this would have to take care of look

after him.

Depression as a form of loyalty to the significant links

A frequent observation in depressed patients is the relationship between depression

and some very traumatic events suffered by people very close such as the rape of a

family member, an accident or illness that caused the invalidity of any of them,

suicides of parents or siblings, mothers who die in childbirth of the patient, family

members or die premature deaths shocking and so on. In this case patients surviving

loved ones lost trying to repair such offering his health, his happiness or his life in

sacrifice, to make an unconscious repair depressed, give up what others can not reach.

Depression as a form of self-harm

It is the defense mechanism proposed in psychoanalysis as aggression turned against

the self, and is known as retroflection in Gestalt psychotherapy. In certain situations

people are confronted with impotence and can not externalize distress, at other times

feel anger toward someone or something and instead of expressing the repressed. In

such cases it is common for the rage that no action be against the patient in the form

of self-harm. The self is divided into an aggressor and attacked, and the person begins

the endless accusations and insults to himself that are characteristic of depressive

disorders. Gestalt Psychotherapy for depression is a form of communication that tells

us something about how the patient structure their reality, a way and a consequence

of break contact and more than a disease, is the best way that a person has to adapt to

their circumstances. If dispusiese a more appropriate way would use.

Pattern depression and treatment strategies

Ann Clark (1982) published in an article setting out his observations about the

psychotherapeutic work with depressed patients, the sadness had argued that a kind of

pattern and that happened in three stages or phases: the phase of withdrawal,

emotional response and existential acceptance of these three phases have different

characteristics and also imply that the therapist's work and approach the guy who

carries out their depressed patients must be different in each of these three

different moments.

Phase Withdrawal

This is the first stage of depression when the person becomes aware that an imminent

or inevitable change is coming, this is a moment of paralysis the person remains in a

state of apathy and apathy is unable to take adequate or perhaps unable decisions take

any decision, this makes it extremely difficult to contact and do not feel able

to influence the, organismic self-regulation fails and the individual is removed from

the field to the self, the body contact limit thickens environment defensively . The

patient is removed, breaks contact

This does not always have a negative meaning, sometimes this withdrawal is a way to

slow the impact of changes to assimilate as progressive, so that the resources that

then can be scarce or poorly suited for the challenge that faces are not overwhelmed.

In this circumstance insist that the patient Face the reality or insist on the realization

can be very inappropriate, we can make the resources of the person who is in a time

of great vulnerability collapse leaving even more helpless. It is time to observe, to

rely on self-regulation of the patient, letting him accompany being aware of what is

capable of realizing. The best therapeutic approach in the period of withdrawal may

be broach such withdrawal, explore the mechanisms of resistance without fighting

them. This reluctance to embrace change is the expression of the will to live the self

clings to a form of existence that is threatened by change.

The reluctance to accept change is the affirmation of life (Ann Clark 82)

Later in this stage when you are past the initial time the patient's resources are

overwhelmed by the impact of changing the therapist trying to promote some

concrete actions that put the patient in a position to start scanning the organism-

environment field and resources that may exist to address this situation and, if

possible, encourage the exploration of such resources in the therapeutic context. This

time to build together with the patient a bridge from the defensive retreat to the

grieving process.

The therapeutic work during this stage is then to allow time for the healing of the

insulation component first, then encourage the individual to perform less isolated and

that are meaningful in the sense of bringing the patient to contact activities and

maintained throughout the process connected with the person in isolation. For this,

the therapist must use certain personal resources such as sensitivity, timing and time

and a very efficient capacity personal contact. As Ann Clark says the therapist should

notice the power balance between passive withdrawal and active energy indicates the

arrival of the stage of emotional response. The end of this stage is marked by change,

by the acceptance of the loss and body-scanning intone to overcome field. The end of

isolation is the beginning of the match.

Emotional Response Phase

We are facing people who have lost a part of your life means, which is to say that

they have lost a part of the self. They feel incomplete and overwhelmed by intense

emotions. It is common to depression and sadness associated this is the emotion most

frequently addressed in psychotherapy but there are other emotions that overwhelm

the patient throughout the process that must not be neglected by the therapist and no

time. Fear of the future almost permanently accompanies those who have had

significant losses, a fear that can inhibit experimentation and hinders all contact from

the wetted to the contact with their own emotions and resources. The therapist will

have to build trust and encourage the patient to regain the self-confidence by helping

you contact the agency resources-environment field. All this must be done without

pressure on the patient and not lose sight of that fear is not an enemy, rather it is a

source of caution and prudence that the patient may need a lot in this vulnerable

state.

Another frequent and intense emotion at this stage is anger. Unlike what curre with

the fear that is dispersed in various degrees and shades throughout the period, rabies

is usually episodic and alternate with sadness in polar form. Arguably rage and

sorrow are the emotional response of contact and withdrawal. It expresses deep

sorrow unhappiness loss, dissolution of the self that has been expressed anger and

frustration and helplessness before the inevitable loss but also guide the individual

towards new activities and new commitments.

Ann Clark argues that there are three areas in which this polarity is expressed anger

and sadness. The first is related to the unfinished gestalt of the individual's history,

recent losses are added to the burden of grief that come from previous injuries or

losses that may belong from a very early life stages until recently, psychological

defenses individual unfinished business decreased by these allow the sum of the

burden of grief so that the current frame be much more dramatic, or a loss that could

have caused only a period of no pathological mourning turns into a deep depression.

The second area is that of the other immediate experiences other than the loss in

which no emotional conflict, it is important and conflicting relations contained are

made during periods of severe loss due to the contact surface of the individual with

others their environment is disturbed by the previous withdrawal or improper

handling of anger or for fear of losing then other relationships that are significant, the

depressed person can project the anger of the lost of their loved ones or turn into

excess applicant before the fear of losing.

Finally we found the area where existential anger and sadness as alternate losses and

changes make the person is deslazada outside their safety zones. Rabies is usually

aimed at impersonal entities such as God, life or the universe, sadness is strongly

linked to the knowledge that our lives will never be the same, losses require us to

rethink who we are, what is the meaning of life or for serving our existence, then we

confront the unknown and we are powerless to control.

The appropriate therapeutic approach in the period of emotional response is crucial as

this depends on the resolution of depression to take place in the next stage. Chronic

and recurrent depression, treatment resistance and relapse often fixings at this stage to

make the patient close in a vicious cycle of recurring rage and sadness. The

therapeutic work will be to guide the patient in a process that has to reach first realize

the different emotions that are seizing, will differentiate the anger and sorrow of the

other emotional responses of affliction; also you must be able to distinguish between

emotions unleashed by the unfinished gestalt, those caused by conflict and those due

to present their insecurities and existential dilemmas.

The therapist must be able to support the emotional expressions from the crying, the

moodiness and even explosive anger, also the irrational fear that usually occurs in this

period and that during the deep experiences of emotional discharge limits are lost

between the self and the environment and the patient is frightened at the prospect of

losing control of their emotions "... I do not want to mourn because if I start I do not

stop ever," they say. It is important to stress that the work of the therapist is not to

force a situation, it is allowed, facilitates and supports the expression of emotions but

not forced in any way. It is very important to help the development of emotions such

as fear, shame, guilt, hopelessness, envy, frustration and many other emotional

components that are present in this period.

Blame deserves special attention because it is extremely common for depressed

patients responsible for their losses accrues and guilt is unconsciously linked with the

notion of punishment and penance and this can lead to attempts to punish through

retroflexivas that self-harm should be avoided. In this period the therapist must be

able to tolerate the emotional response without forcing and without anxiety at the

violence of expression. A common mistake of therapists in this period is trying to

delete, forward or cushion the impact of emotional shock. This phase ends with the

disappearance of tears and anger.

Existential Phase Acceptance

At this point the person makes a reassessment of his life in the light of the events for

which he has gone through. What began as an emotional response begins to integrate

with the cognitive components of that experience and earlier. The patient tells his

story repeatedly reliving the loss repeatedly, and on each occasion is assigning and

reassigning meaning to the experience until the result seems appropriate since

emotionally and cognitively, then understanding and learning that do arise Copper

sense that the experience and would constitute a present experience able to reassure

and define the future. Existential anger and sadness are integrated with cognitive

experiences causing the patient to explore their responsibility for the events,

questions why did this happen to me? and why it happened to me right now? They are

more than one complaint, are a close contact with the mistakes, carelessness and

incompetence of the past, these questions now demand a coherent response which

becomes a tool to guard in the future. a dramatic and emotional negotiation with

existence, with God and with himself, consistent proposals appear to face similar

situations and alternatives are explored in an almost obsessive way, "If I had done ..."

"If I had said it begins ..." They are leading a multitude of alternative proposals.

These proposals represent a strong commitment to change.

The hopelessness caused by current loss experience and any earlier due to therapeutic

interventions begins to give way to acceptance and learning, self integrity is restored.

The integration of polarities weakness / strength, guilt / responsibility, virtues / flaws,

efficiency / consistency inability to confer self and this is manifested by an efficient

interaction of cognitive, emotional and behavioral components of the individual's

existence. But at the same time people learn to manage in a world where there's

uncertainty and ambiguity

In this period the therapist must take an active part in the integration of polarities and

the use of suppressive techniques to stop attempts to stop the increasing contact of the

individual and the body's resources-environment field. If the therapist self-conscious

at the intensity of some emotional expressions or before the drama of some cognitive

constructions may hinder the emergence of gaining acceptance only an attitude of sad

resignation. The therapist does not explain, comfort, tackles acute and consciously to

promote the integration experience of loss.

Techniques used in Gestalt Psychotherapy

Perhaps the best known systematization of intervention techniques used in Gestalt

psychotherapy is the one made by Claudio Naranjo. These techniques aim to develop

in the patient a triple attitude that consists of an ability to become conscious personal

experience, an ability to live in the present and the ability to take over their

responsibilities without incurring games and manipulations. Gestalt techniques are

grouped into three categories.

Expressive consisting ask the patient to repeat a gesture, a posture, a movement or a

cry or that exaggerate with the intention that the patient comes into contact with

repressed emotion, or a hidden belief.

Suppressive techniques that aim to lead the patient to take responsibility for their

existence, by improving the way they express the facts that makes the emotions and

thoughts and housing; To do this, the patient is encouraged to delete a series of verbal

expressions intended to shift out of it the burden of what happens to him, we prefer

that patients talk to who have difficulties to talk about them, although it should be

done through the strategy of the empty chair, the story is not important, but the

emotion and impulses that move with direct communication person to person.

Moreover, when someone talks about what is happening it tends to make judgments,

to try to explain intellectualizing and away from the feelings that this will occur. This

is what gestalt known as the scientific game.

Patients are also encouraged to avoid clichés such as "I feel good," to mention the

excitement you feel, "I am happy" or "I feel calm, calm "they are much more

expressive and help people to be explored in search of their emotions. Diagnostic

philosophical explanations and games are avoided. The "debeísmos" or religious

games are also rejected in the gestalt model of communication as they serve

predominantly for manipulating, inciting others in the emergence of emotions like

shame and guilt. "I must" or "have to" are changed to "want" or "prefer". People

make more decisions that actually agree to take and a lot of times seek to blame

others, or circumstances, the decisions they make.

The technical integration of the elements disintegrated personality, seeking to

integrate these components of personality that have polarized or never merged, it is

done through a strategy that is one of the cornerstones of psychotherapy gestalt, it is a

of the best known and successful integration tools: Empty chair the call. This is a

physical space (chair, sofa, cushion, etc.) in the therapeutic practice, intended to

accommodate the disintegrated parts, opposing parts of the personality of the patients,

which act as opposing forces in a specific situation in life East. It can also be

occupied by the internal representation that a person has of those who interact with

real people in their daily lives. Through the empty chair is conducted a dialogue

between the parties of personality emerge negotiations and integrate and reconcile the

scattered and conflicting aspects. Patients placed in the chair in front of him to part

with it will interact and changing seats, all parties acting as a theatrical performance

full of emotional nuances.

In Gestalt also working with dreams in Gestalt conception dreams they must be

interpreted by the dreamer with the assistance of a psychotherapist. Each element of

the dream represents a segment of the personality of the dreamer. So if someone

dreams, for example, which is in a desolate house talking to his grandmother, each of

the elements of this dream represents a part of himself that conveys a valuable insight

into his unconscious attempts to find solutions to the difficulties, which the individual

goes through in her life watching, consciously or unconsciously. In therapy gestalt is

not a unilateral interpretation of dreams is made, counting as a past history. It is as if

reliving a fact that is happening in the present, each component act, interpret for each

person to be involved in their sleep and reinstate all the personality of the

segments represent.

To conclude

Gestalt psychotherapy is not an impromptu invention, it is a current scientifically

substantiated by a method, a philosophy and a structured research that makes it closer

to the social sciences body. Heir of psychoanalysis, Gestalt psychology,

Psychotherapy Existential, Phenomenology and Humanistic Psychology among other

influences. Has years of tradition, experience and a growing body of research that

supports the methodology and results presented in this paper.

Gestalt Psychotherapy is among the six most effective current professionals with

more research, formed through the world and more demand from patients.

This work aims to show how we understand and how we deal with one of the diseases

that plague humans in this century. Also as we learn from our experience and we let

go of the dogmas, to be in resonance with the challenges of ensuring balance, well-

being and mental health of our patients and help them recover them when necessary.

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