Relational Aspects of Intersubjectivity Therapy and Gestalt Thera

8/13/2019 Relational Aspects of Intersubjectivity Therapy and Gestalt Thera

1/59

Pacic University

CommonKnowledge

School of Professional Psychology eses, Dissertations and Capstone Projects

4-15-2005

Relational Aspects of Intersubjectivity Terapy andGestalt Terapy: A Teoretical Integration

Jane S. LarsonPacifc University

is Dissertation is brought to you for free and open access by the eses, Dissertations and Capstone Projects at CommonKnowledge. It has been

accepted for inclusion in School of Professional Psychology by an authorized administrator of CommonKnowledge. For more information, please

contact [email protected].

Recommended CitationLarson, Jane S. (2005). Relational Aspects of Intersubjectivity erapy and Gestalt erapy: A eoretical Integration (Doctoraldissertation, Pacic University). Retrieved from:hp://commons.pacicu.edu/spp/4
http://commons.pacificu.edu/http://commons.pacificu.edu/spphttp://commons.pacificu.edu/etdsmailto:[email protected]:[email protected]://commons.pacificu.edu/etdshttp://commons.pacificu.edu/spphttp://commons.pacificu.edu/


2/59


3/59

Copyright and terms of use

If you have downloaded this document directly from the web or from CommonKnowledge, see theRights section on the previous page for the terms of use.

If you have received this document through an interlibrary loan/document delivery service, the

following terms of use apply:

Copyright in this work is held by the author(s). You may download or print any portion of this documentfor personal use only, or for any use that is allowed by fair use (Title 17, 107 U.S.C.). Except for personalor fair use, you or your borrowing library may not reproduce, remix, republish, post, transmit, ordistribute this document, or any portion thereof, without the permission of the copyright owner. [Note:If this document is licensed under a Creative Commons license (see Rights on the previous page)

which allows broader usage rights, your use is governed by the terms of that license.]

Inquiries regarding further use of these materials should be addressed to: CommonKnowledge Rights,Pacic University Library, 2043 College Way, Forest Grove, OR 97116, (503) 352-7209. Email inquiriesmay be directed to:. [email protected]

is dissertation is available at CommonKnowledge:hp://commons.pacicu.edu/spp/4
mailto:[email protected]://commons.pacificu.edu/spp/4http://commons.pacificu.edu/spp/4mailto:[email protected]


4/59


5/59

TABLE OF CONTENTS

ABSTRACT iiiACKNOWLEDGrvfENTS .ivrnTRODUCTION 1OVERVIEW OF INTERSUBJECTIVITY THEORY AND PRACTICE 9OVERVIEW OF GESTALT THEORY AND PRACTICE 17RELATIONAL ASPECTS OF INTERSUBJECTIVITY THERAPY AND GESTALTTIIERAPY .. . . . . . . 28SYNTHESIS AND EXTENSION OF THE RELATIONAL ASPECTS OFrnTERSUBJECTNITYTHERAPY AND GESTALT THERAPy 37SUMMARY AND CONCLUSION . 49REFERENCES 5


6/59


7/59

ACKNOWLEDGEMENTS

This dissertation would not have been possible without the affirming support andencouragement of Jon Frew Ph.D. my dissertation Chair and Sandra Jenkins Ph.D. myReader both of whom have been a vital part of my experience at SPP. I would also liketo thank my parents Bill and Barbara Larson for their unstinting support of my effortsthese past five years and for their vital financial contribution to this degree. Finallywish to thank my partner r. Caroline Litzenberger for her patience good humortechnical expertise encouragement and love which has served to sustain and strengthenme throughout this process.

iv


8/59

RELATIONAL ASPECTS OF INTERSUBJECTIVITY THERAPY ANDGESALT THERAPY:

A THEORETICAL INTEGRATIONINTRODUCTION

The concept of psychotherapy integration has been alive in the field ofpsychology for many years, starting with attempts to convert Freudianpsychoanalytic concepts into the terms of learning theories (Stricker Gold,1996). These ideas evolved slowly, and it was not until the 1980 s that realinterest and respect for psychotherapy integration took hold in the psychotherapyliterature (Castonguay Goldfried, 1994). Several interacting variables identifiedby Norcross and Newman (1992) contributed to the popUlarity and utility ofpsychotherapy integration, including growth in the number of separate therapytypes, the failure of anyone therapy to be shown superior to any other, the growthof the short-term therapy phenomenon, increased dialogue between cliniciansfrom diverse theoretical backgrounds, the increasing pressure from third-partypayers for accountability from psychotherapists, and perhaps most importantly,the identification of the common factors present in ll psychotherapies that arerelated to successful outcomes (Norcross Newman, 1992).

Psychotherapy IntegrationPsychotherapy integration is characterized by openness to various ways

of integrating diverse theories and techniques (Arkowitz, 1992, p. 262), with thegoal of providing more effective p s y h o t h e r ~ p e u t i treatment for our clients.

1


9/59

Stricker (1994) cites the law of the instrument when he points out that we mightdo very well with a hammer on jobs that use nails, but the possession of a full

tool box is in the best interest of both the carpenter and the project (Stricker,1994, p.3). A full tool box is an apt metaphor for the necessity of employing arange of techniques, encompassing more than one theory, in the hopes of mosteffectively treating our clients.

Psychotherapy integration, however, does not advocate using just anytechnique that works, regardless of its theoretical underpinnings. To do so wouldbe to practice a theoretically eclectic approach, a different philosophy whichemploys multiple techniques. Rather, the integrative approach attends to therelationship between theory and technique (Stricker, p.3), and is open toalterations with the acquisition of new research data and clinical experience. tadopts a more process-oriented philosophy, using the responses of the client andthe goals of the therapy s guidelines.Changes In ttitude

The increasing use of integrative approaches in the past thirty yearsillustrates an important point about how the field of psychology and its practicehas changed. The field has adapted to provide more effective treatmentmodalities, and no longer forces the clinician to be limited by one cherishedtheory. As Castonguay and Goldfried (1994) state,

the most significant change has been the progressiveabandonment of an attitude of complacency and orthodoxy withineach major orientation- psychodynamic, humanistic-experiential,and behavioral- and the gradual emergence of an open-mindednesstoward the possible contributions of other theoretical approaches(Castonguay Goldfried, 1994, p.159).

2


10/59

This change in attitude frees clinicians to integrate theories judiciously that arecomplimentary and seem to speak to each other in helpful ways. wo suchtherapies are intersubjectivity therapy and Gestalt therapy. While these twotheoretical orientations may seem miles apart conceptually, there are several areasof crossover worth exploring.

Intersubjectivity Therapy and Gestalt TherapyIntersubjectivity theory is based on the premise that both the client nd

the therapist bring something of themselves and of their respective past emotionalexperience to the therapeutic relationship. This theoretical orientation is veryattentive to the dynamics in the therapy room, especially of the relationshipbetween therapist and client. t attends to how the client and the psychotherapistinteract with each other, as well as how they feel about each other, consciously

and subconsciously. However, unlike Gestalt theory, this theory also focusesheavily upon the client s interpersonal history, and the client s feelings aboutearly, important objects, which inform and shape this present relationship with thepsychotherapist. Within this theoretical framework, the therapist strives to trulyunderstand each client s subjective experience in the hope of providing accuratelyempathetic responses.

Gestalt theory and therapeutic practice has tended to emphasize the powerof the present tense perspective, and has focused on what is enacted in the therapyroom, including the therapeutic relationship. Gestalt psychotherapy practice hasnot tended to focus on past experiences, relationships, or feelings, except as pastexperiences of the client become salient in the present moment. Instead, Gestalt

3


11/59

therapy uses the immediate psychotherapy experience as the laboratory in whichto increase the client s awareness of issues and feelings previously out of

awareness. Within this therapeutic laboratory, the Gestalt therapist seeks to fullyunderstand the client s unique phenomenology, as it plays out in the therapyroom. By so doing, the client may feel fully heard and accepted by the therapist,and gain heightened awareness of the issues at hand.

t seems clear that intersubjectivity therapy and Gestalt therapy approachthe task of psychotherapy with a somewhat different focus, yet similarities areapparent between the two. Both theories wish to increase client awareness, thoughthey m y achieve that goal in different ways. Both theories are humanistic,emphasizing the importance of understanding the phenomenology/subjectiveexperience in the client s intersubjective/phenomenological field. And, perhaps asa result of that understanding, both theories use the therapeutic relationship as anintegral aspect of their psychotherapy. This emphasis on the importance of thetherapeutic relationship leads to a discussion of the importance of relationalaspects present in both theories.Relational spects o Intersubjecticity Theory and Gestalt Theory

While it is beyond the scope of this work to fully integrate Gestalt theorywith intersubjectivity theory, it is possible to examine the relational aspects thatdrive them both in important ways. The importance of the therapeuticrelationship and other relational aspects is acknowledged and utilized by boththeoretical orientations. The two theories frequently use similar language whendiscussing the importance of the therapeutic relationship and other relational

4


12/59

aspects within psychotherapy, but may conceptualize very differently. Thesedifferent ways of conceptualizing and utilizing various relational aspects can be

combined to create a synergistic result enhancing the practitioner s therapeuticeffectiveness and thus the potential of better psychotherapeutic outcomes.

ProposalThis dissertation proposes to investigate and integrate relational aspects of

intersubjectivity theory and practice with Gestalt theory and practice. he intentof this synthesis and extension of the existing literature is to improve therapeutictechnique and provide more effective psychotherapy to clients through a partialtheoretical integration of these complimentary theories.

A comprehensive review will provide a brief history and over-view ofintersubjectivity theory and practice, primarily drawing on the writings ofStolorow and Atwood (1984, 1995), and Buirski and Haglund (2001), and others.Starting with its roots in Freudian psychoanalytic theory, the ways in whichintersubjectivity therapy conceptualizes clients and their issues will be explored.This will be followed by a brief overview and history of Gestalt theory, using thewritings of Peds, Hefferline and Goodman, (1951), and Polster and Polster(1973), and others. Again, starting with it roots in Freudian psychoanalytic theory,the ways Gestalt therapy conceptualizes clients and their issues will be explored.This will be followed by a review of relational aspects within intersubjectivitytherapy and relational aspects within Gestalt therapy. Finally, a synthesis andextension of the relational aspects of these two theories will be provided, looking

5


13/59

at the current literature on the integration of intersubjectivity therapy with Gestalttherapy, exploring how best to integrate these two modes of psychotherapy in

order to provide a more powerful and comprehensive treatment modality withwhich to treat our clients. Several clinical vignettes from the author s practicewill e provided s n illustration of how this integration might look in actualpractice.

Brief Literature ReviewA preliminary review of the literature pertaining to the integration of

various aspects of intersubjectivity therapy and Gestalt therapy reveals that thereis some interest in integrative thinking within these two theories, though most donot focus exclusively on the relational aspects of each theory. Yontef (2002)posits that Gestalt therapy is systematically relational in its theory andmethodology, though t has not always emphasized that fact, and discusses amethodology for assimilating psychoanalytic perspectives into Gestalt theory andpractice (Yontef, 1988). Both Jacobs (1992) and Breshgold Zahm (1992) gleaninsights from self-psychology and intersubjectivity theory to enhance theireffectiveness s Gestalt therapists. They discuss several complimentary conceptsfrom Gestalt theory and intersubjectivity theory (including relational aspects fromeach), which often use different language to express very similar ideas. The workof Hycner Jacobs (1995) on the use of the therapeutic relationship in Gestalttherapy discusses in detail the intersection of intersubjectivity theory and itsusefulness to Gestalt therapy. They discuss the role of dialogue in therapy and theintegration of intersubjectivity theory, self-psychology, and Gestalt therapy

6


14/59

Hycner Jacobs, 1995). Tobin 1982) discusses the integration of Gestalttherapy and self-psychology, with some emphasis on the similarities between the

two theories regarding the importance of the relationship in psychotherapy.The above literature, s well as other works on this subject, will be used as

a springboard to facilitate an integration of the relational concepts utilized inintersubjectivity therapy and Gestalt therapy. By focusing solely on the relationalaspects within each of these theories, the complimentary nature of the twotheories will be shown, as well as how aspects of each theory may inform andguide the other. y crossing theoretical boundaries, new layers of meaning will berevealed, and a new, more fully integrated theory will be created. Treatment maybe improved by this broadened analysis, and may be more effective for a largertherapeutic population. This synthesis will provide a new therapeutic framework,giving therapists a comprehensive and integrated theory with which to treatclients. y integrating the basic Gestalt principle of orientation to the presentparticularly the current relationship between client and therapist) combined with

an intersubjective focus on early object relations particularly how those pastexperiences play out in the current therapeutic relationship), we use the best ofboth theories to increase client awareness of both the past and present, and thedynamic interplay between them.

The format of this dissertation will be s follows:-Introduction-Overview of intersubjectivity theory and practice

7


15/59

-Overview of Gestalt theory nd practice-Exposition of relational aspects of both theories

-Synthesis nd extensionof relational aspects of the two theories with severalclinical vignettes provided s illustrations

8


16/59

OVERVIEW OF INTERSUBJECTIVITY THEORY AND PRACTICE

o understand the potential interplay between intersubjectivity theory and Gestalttheory, it is important to look first at each theory separately and examine its genesis.Intersubjectivity theory has its roots in psychodynamic theory, particularly the more

relational schools, such as self psychology and interpersonal theory. t is the logicaloutcome of the progression from Freud s classical drive theory to Sullivan s interpersonalfield theory, to Erikson s analysis of the human life cycle and concepts of identityformation. From there, it flows from Klein s, Mahler s, and Bowlby s work in the area ofattachment and parenting, to Winnicott s expansion of those theories into the area ofparent-infant bonding, to Kohut s concepts of the self (Mitchell Black, 1995). Ascited by Orange, Atwood, and Stolorow (1997),

Kohut insisted that the entire domain of psychoanalytic inquiry issubjective experience. He implicitly rejected drive theory, along withmetapsychological constructs generally. The only data for psychoanalyticunderstanding, Kohut believed, are those that are accessible byintrospection and empathy. [Intersubjectivity theory] completely acceptsself psychology s most fundamental tenet, its definition of the sources ofpsychoanalytic inquiry and understanding as well as its conviction thatself-experience is radically context-dependent- that is, rooted in specificcontexts of relatedness (Orange, Atwood, Stolorow, 1997, p.6).

This definition of intersubjectivity theory clearly illustrates the fact that relational aspectsare vital to how it works with clients in the therapy room.

9


17/59

Intersubjectivity TheoryIntersubjectivity, as defined by two of its primary theorists, posits that

psychoanalysis seeks to illuminate phenomena that emerge within a specificpsychological field constituted by the intersection of two subjectivities- that of the patientand that of the analyst (Atwood Stolorow, 1984, p 64). This view differs radicallyfrom the Freudian concepts of neutrality, scientific empiricism, and the God's-eye viewof the therapeutic enterprise. Intersubjectivity as practiced in psychotherapy viewspsychoanalysis as the dialogic attempt of two people together to understand one person'sorganization of emotional experience by making sense together of their intersubjectivelyconfigured experience (Orange, 1995, p 22). In this construction, both therapist andclient each use their subjective experience to make sense of how they interact with andaffect each other. Orange and colleagues (1997) illustrate this further when they state,

Intersubjectivity theory is not a set of prescriptions for clinical work. t is asensibility that continually takes into account the inescapable interplay ofthe two subjects in any psychoanalysis. t radically rejects the notion thatpsychoanalysis is something one isolated mind does to another, or thatdevelopment is something that one person does or does not do. Workingintersubjectively is exploring together for the sake of healing (Orange, etai, 1997, p. 18).

Differences between Intersubjectivity Theory nd Traditional nalytic Theories

Because intersubjectivity theory evolved from more traditional analytic theories,it is best illustrated by showing how it differs and contrasts from earlier theories. One ofthe fundamental ways that intersubjectivity theory differentiates itself from moretraditional theories of psychoanalysis is its departure from the Cartesian doctrine of theisolated mind. Freud utilized this concept in many ways, using it in the formulation of his

1


18/59

ideas regarding transference and therapist neutrality, and in his perceived separatenessfrom his patient. This doctrine serves to split the inner, subjective experience of the

individual into visible and invisible regions, reifies and absolutizes the resultingseparation between the two, and pictures the mind as an objective entity that takes itsplace among other objects, a 'thinking thing' that has an inside with contents and looksout on an external world from which it is essentially estranged (Stolorow, Atwood,Orange, 2002, p.1). This conceptualization of human experience has pervaded modemthought about the nature of reality, and, within the field of psychology, has wieldedenormous influence over how we think about our selves, our feelings, and our experienceand expression of those feelings. t has helped to reify the idea that we are separate fromour true selves and unable to access that self without the assistance of a neutral other.n fact, Freud encouraged the idea that we might not fully know who we are, and thus, we

are in need of a neutral guide to lead us home. Letting go of the image of the neutral andobjective analyst presents a challenge, especially when that image must be replaced by atherapist who is more vulnerable t the client's pain. As Orange and colleagues (1997)put it,

The ideal of the neutral and objective analyst, impenetrable and sage like,is just such an image, in that it disavows the deeply personal impact of theanalyst's emotional engagement with patients and denies all the ways inwhich the analyst and his or her own psychological organization areprofoundly implicated in all the phenomena he or she observes and seeksto treat (Orange, et al., 1997, p.42).

From an intersubjective perspective then, the analyst must be willing to be affected andmoved by what the client brings to the therapy. This emotional availability on the part ofthe therapist sets the entire therapeutic relationship in motion.


19/59

Heidegger s philosophical modelIn contrast to the philosophy of the isolated mind, early intersubjective theorists

adapted the philosopher Heidegger's contextual vision, (1962) in which human Being issaturated with the world in which it dwells, just as the inhabited world is drenched inhuman meanings and purposes (Stolorow, et aI 2002, p.9). Intersubjective orientedtherapists works to understand the client's inner phenomenology partly byacknowledging what they, as therapists, bring to the consulting room. The therapist's

own interpersonal experiences, and the meanings they have drawn from thoseexperiences, form an essential grounding in their understanding of the issues, feelings,and meanings their clients bring.Affect and Context

Another contribution from Heidegger's thinking concerns the importance ofaffect, a basic dimension of human experience. He described it as a mode of living, ofbeing-in-the-world, profoundly embedded in constitutive context. Heidegger's concept.underscores the exquisite context-dependence and context-sensitivity of human emotionallife (Stolorow, et aI 1995, p. 10). This idea of context is one of the corner-stones ofintersubjective thinking. Context is one of the most salient concepts for theintersubjective therapist to utilize when conceptualizing a client. Acknowledging andusing the client's unique context enables the therapist to understand the meanings theclient has made from experience, helping to bring those to awareness. Stolorow andAtwood (1992) state convincingly that:

the concept of an intersubjective system brings to focus both theindividual's world oOnner experience and its embeddedness with othersuch worlds in a continual flow of reciprocal mutual influence. In this

12


20/59

vision, the gap between the intrapsychic and interpersonal realms isclosed, and, indeed, the old dichotomy between them is rendered obsolete(Stolorow Atwood, 1992, p. 18).

bstinence versus EmpathyOne other contrast between intersubjectivity theory and more traditional theories

concerns abstinence versus empathy. Freud .practiced under the dictum of abstinence, thatis, the idea that the analyst should not give in to the client 's desire and need for empathy,understanding, and instinctual satisfactions . e thought that to do so would render himno longer neutral, and thus contaminate the transference, which needed to remain pure .As stated by Orange and her colleagues,

This technical injunction derived from the theoretical assumption that theprimary constellations with which psychoanalysis is concerned areproducts of repressed instinctual drive derivatives. Gratification, accordingto this thesis, interferes with the goalsof bringing the repressed instinctualwishes into consciousness, tracking their genetic origins, and ultimatelyachieving their renunciation and sublimation (Orange, et al., 1997, p 36).

Many arguments have arisen from more contemporary, relational theorists, stating that tofrustrate the client's wish to connect is not perceived as neutral or therapeutic, and in fact .could be damaging. As several theorists have pointed out so-called transferenceneuroses , thought by many to be the sine qua non of an analytic process, may actually beiatrogenic reactions to the indiscriminant application of the principle of abstinence. Thusan attitude of abstinence not only may fail to facilitate the analytic process; it may beinimical to it (Orange, et al., 1997, p 36).Sustained empathic inquiry

Intersubjective theorists have replaced the notion of abstinence with a verydifferent construct: sustained empathic inquiry. This philosophy posits that with

3


21/59

sustained, empathic attention to the client s concerns, there is a greater possibility that theclient s subjective world will be illuminated and understood (Stolorow, Brandchaft,

Atwood, 1995). Stolorow goes on to state,Like the rule of abstinence, the empathic stance decisively shapes thetherapeutic dialogue, but in an entirely different direction. Sustainedempathic inquiry by the analyst contributes to the formation of anintersubjective situation in which the patient increasingly comes to believethat his most profound emotional states and needs can be understood indepth. This, in turn, encourages the patient to develop and expand his owncapacity for self-reflection and at the same time to persist in articulatingever more vulnerable and sequestered regions of his subjective life.Equally important, it progressively establishes the analyst as anunderstanding presence with whom early unmet needs can be revived andaborted developmental thrusts reinstated (Stolorow, et aI., 1995).

t seems that this stance more than any other establishes intersubjective theory asprimarily relational in many aspects. Therapists may use themselves as instruments withwhich to help clients recognize and articulate thoughts and feelings previously out oftheir awareness.Pathology

A related characteristic of intersubjective theory is itsperspective on pathology.Unlike traditional drive theory, where the patient is conceptualized as dysfunctional and aslave to unresolved inner conflicts and drives, intersubjectivity seeks to conceptualize theclient as creative and adaptive in their behaviors. In Making Sense Together Buirski andHaglund (2001) use this different construct to understand their clients.

Through the intersubjective lens, patients are not viewed as trying to hideor dress themselves up. Rather, their presentations are seen as dynamicsolutions to the universal problems of managing affect within theirindividual developmental contexts. y appreciating this adaptive solutionand the complex system from which it emerged, the client s effOlts ofstriving toward health is affirmed, as opposed to a focus on pathology .

4


22/59

When the therapist responds from this perspective, the patient can feelmore real to himself and more trusting in his perceptions and his ownexperience (Buirski Haglund, 2001, p.4),

Therefore, intersubjective thought is what might be called non-pathologizing , beingwilling to attempt to understand the client's motivations and desires to feel better in theworld, and see these attempts in the client's unique emotional context.

Conclusion to Overview of Intersubjectivity SectionIntersubjective theory and practice may be thought of s relational, context

dependent, non-pathologizing, and willing and able to enter into the client'sintersubjective field. t is a way of thinking that takes into account not only the client'sexperiences and inner meanings made from those experiences, but also takes into accountthe therapist's inner workings and experiences. From that combination of experiences andmeanings the client has a chance to feel heard, understood, and ultimately healed of theinjuries that brought them to treatment in the first place. The guiding principle for thismethod of conducting psychotherapy is the notion that reality cannot possibly beobjective. We cannot know the client's reality because it s subjective. What we canknow is our own reality and emotional experiences, and using those tools, look for waysto validate and understand our client's experience. As Stolorow and his colleagues put it,

A fundamental assumption that had guided our work is that the only reality relevant andaccessible to psychoanalytic inquiry (that is, to empathy and introspection) is subjectivereality- that of the patient, that of the analyst, and the psychological field created by theinterplay between the two (Stolorow, et a11995, p.4). Intersubjectivity theory provides amethod with which therapists may move toward the client, rather than stand back inan effort to remain objective. Clients can be helped in new ways by having

15


23/59

intersubjectively oriented therapists who are willing to ride the emotional roller coasterwith them on a journey toward mutual discovery.

6


24/59

OVERVIEW O GESTALT THEORY AND PRACTICE

Because Gestalt therapeutic practice stems more from a philosophy than a theory,it remains difficult to define. The German word gestalt has no direct Englishtranslation, but may be defined as a whole form that cannot be broken up without

destroying it. The relationship between the parts of the whole cannot change withoutdestroying the particular gestalt (Latner, 1973). This identifying, defining principle willbecome clearer as Gestalt therapy is further discussed. Related to the concept of thegestalt is the idea that this therapy is a theoretical system which embraces health, not

pathology. The clients we see are not sick , neurotic , or engaging in maladaptivebehaviors. Rather, every individual has the capacity to self-regulate and finds the bestpossible solutions to the environmental challenges life offers (Frew, 2004, p 10). Thisconcept of clients making creative adjustments to environmental challenges connects tothe intersubjective idea put forth in the previous section that conceives clients ascreatively managing the challenges of their lives and the affects those challenges create.Gestalt therapy takes the same, non-pathologizing stance.istory

Like intersubjectivity therapy, Gestalt therapy has its roots in Freudianpsychoanalytic theory, but rather than growing out of that theory (as did intersubjectivetheory) Gestalt theory and psychotherapy was designed as a refutation and total revisionofFreudian principles. The founders of Gestalt therapy, Fritz PerIs, who was originally

17


25/59

trained as a Freudian analyst, and his wife Laura became exposed to the philosophicalideas of Heidigger and others (which also influence intersubjectivity theory, as illustrated

in the previous section) and began developing a philosophy of psychotherapy that wasradically different from Freud's emphasis on drives, the significance of past experiences,and the interpretation of past experiences. Gestalt therapy emphasized the presentmoment, the process as it is played out in the therapy room, and experimentation withthat process (Frew, 2004).

Organizing PrinciplesAn organizing principle of Gestalt therapy is the concept of holism, which can be

defined as conceptualizing that all of nature and humanity is a unified and coherentwhole (Latner, 1973, p.6). From this we derive one of the most important concepts'ofGestalt therapy: that the whole is greater than the sum of its parts. As stated in TheGestalt Therapy Book

We are not simply an accumulation of functions we are more interestedin integration than analysis. Because we are looking for the ways in whichthings come together, we attempt to understand them in ways that bringthem together, rather than in ways that separate them. Therefore, we areattuned more to the processes and principles that reoccur in behavior thanto the temporary forms these processes take (Latner, 1973, p 7).

The concept of process serves to differentiate from content, Le., what is actuallyarticulated in the therapy room. Process refers to how the client communicates with thepsychotherapist, in things such as intonation, posture, articulation, affect, etc. Gestalttherapy is a process-oriented approach in the sense that it focuses on various aspects ofthe therapist-patient field in the therapeutic interaction (Bresgold, 1987, p.2S). Thisleads to a discussion of the underlying philosophical principles of Gestalt therapy.

18


26/59

hilosophical principlesSeveral overarching philosophical principles inform and define how Gestalt

therapy is practiced: field theory, phenomenology, and dialogue. Field theory derivesfrom early 20th century physics, which uncovered and described the electromagneticforces of the field that surrounded people, things, and animals. These discoveries led tothe development of field theory by the social scientist Kurt Lewin in the 1930's. Histheory was then adopted by Fritz and Laura eds as they developed their concepts of

what comprised Gestalt therapy. Intrinsic to field theory is the human urge to completeinteractions and desires, and the concepts of figure and ground within the field. As statedearlier, the word Gestalt may be defined as a whole or a complete pattern which cannotbe broken without destroying its nature. We make patterns and wholes of ourexperience: we have a spontaneous urge to complete or make meaning out of perceptualstimuli (Mackewn, 1997, p. 15). Therefore, the field is comprised of the totality of theexternal and internal environment of the self. In Gestalt psychotherapy, the field isimpacted by both therapist and client in a reciprocal relationship that is interdependent,horizontal, and dynamic. The field is comprised of both foreground and background, andthe job of the Gestalt therapist is to attend to whatever is figural, that is, in theforeground. Everything is considered of equal importance, going back to the concept ofthe Gestalt- that is, the whole matters, with no part being more important or deserving ofattention that another.

henomenologyPhenomenology describes the client's subjective experience which the therapist

strives to understand from the perspective of the client. Part of this process for the

9


27/59

therapist is to bracket off assumptions that they may have about the client 's experienceof his or her subjective reality. This philosophy posits that there is no objective reality per

se, which echoes concepts from the previous section on intersubjectivity theory whichstates the same thing, showing how well these two theories complement each other. Astherapists attempt to understand the client's phenomenology, they are helped by havingthe client describe rather than explain. Gestalt therapy gears itself to the present momentand gains much more from the client telling how rather than why. As Latner describes it,

This is a present-centered activity. f we ask why instead of how wewould look at the past for causes , but the holistic approach, stressing theactivity itself and its context, eschews history in favor of the here-andnow. The emphasis is on phenomena, on the present as it can be knownthrough empathy, observations, and experience (Latner, 1973, p 10, 11).

Phenomenology is not just a way of entering the client's subjective reality as it presentsitself to us in psychotherapy; it is also a way of understanding that reality from theclient's perspective rather than our own.Dialogue

The third philosophical principle is that of dialogue. Dialogue with the clientrequires that the therapist be truly present with the client in the therapy room. This meansthat the therapist must be available for what theologian Martin Buber termed an I-Thourelationship, those moments of grace and encounter between person and person. Thisdiffers from an I-It objective relationship, which often comprises how our day-to-dayinteractions take place. An I-Thou relationship, (or moment), consists of authenticrelating, total presence, and confirming reality as it is expressed by the client. The I-Thou mode of relating has the qualities of immediacy, directness, presence, and

20


28/59

mutuality. These qualities create a therapeutic relationship that is not hierarchical and ameeting between a patient and therapist that is in and of itself healing (Zahm Gold,

2002, p.864). Dialogue requires active personal involvement, as the therapist meets theperson, rather than attempting to change them. The idea of healing through meetingcomes up frequently in the Gestalt literature, and illustrates the basic accepting stance ofGestalt therapy. Dialogue serves to enhance that encounter in which the client feelsunderstood and accepted in the present moment.

The Paradoxical Theory of ChangeNow that the basic tenets of Gestalt therapy have been articulated and

discussed, an explication of how Gestalt therapy conceptualizes change is necessary.First, the primary Gestalt principle of change is that of increasing client awareness.Increasing client awareness with no overt focus on change allows the client to be exactlywhom and where he or she is. This awareness has the paradoxical effect of allowingchange to happen. Symptoms are not typically the primary focus in Gestalt therapy.Gestalt therapy strives to provide a holistic environment where the client may begenuinely herself. This freedom for clients to be themselves gives the therapist myriadclues and information of how clients have attempted to deal with conflicts in the field. Byallowing clients to be authentic and understanding their phenomenology, the therapyencounter creates the circumstances which increase client awareness. By focusing onmoment-to-moment process in the therapy session, the Gestalt therapist works with howthe person creates and maintains her particular experience of self and other, and how thisexperience impacts the current situation (Zahm Gold, 2002, p 864). From thisfollows spontaneous change, as the client becomes more aware. Gestalt therapy focuses

21


29/59

on showing clients their capacity for creating solutions. This gives clients skills that willhopefully be generalized to other troublesome aspects of life.

Clients come to therapy most often because they perceive that there is somethingwrong with them, their lives, and/or the people around them. The paradoxical theory ofchange posits that people change when they accept who they are and give up on thestruggle to become what they think they should be. This entails the awareness mentionedpreviously; they need to become fully aware of who they are. Not only that- they thenneed to accept who they are This approach requires patience and skill because so manyclients come to psychotherapy wanting their therapists to facilitate change in their lives.The Gestalt therapist resists being a traditional change-agent, wanting rather to help theclient increase their awareness and to become their own agent of change. Mackewn(1997) states:

The more we push for change, the more we are likely to activate acounter-force within the individual or their field which pushes againstchange and seeks to maintain the status quo. n addition, if we join withthe side of the client which wants to change, we will be joining forces withone part of the client only; so we will have abandoned the position ofworking with the whole person of the client and although clients m ytemporarily express satisfaction, in the long-run they are less likely to feelconfirmed in their whole being (Mackewn, 1997, p 65).

Again, this harkens back to the defining principle of Gestalt therapy- the importance ofthe whole, with no part more important than another.Organismic Self regulation nd Figure Formation

Gestalt therapy "is rooted in the proposition that individuals are inherently self-regulating" (Frew, 2004, p 17). This means that human beings know what they need tomaintain their equilibrium and act in their environment to attain that need. This begins

22


30/59

when we are babies and need food or nurture; we cry, and hopefully the present need ismet. This illustrates in a simple, biological way the concept of organismic self-regulation.

Therapy presents more complex scenarios with which our clients grapple. Clients seek tomove beyond simply maintaining their emotional equilibrium to issues of identity, self inthe world, and self-perception. These issues constitute what is often at the forefront of theclient's current experience; as Gestalt theory would have it, they are figural . n Gestaltterms what is figural and what is in the background of the field is ever-changing anddynamic. The process of awareness and contact creates a cycle that works to provideorganismic self-regulation in our daily lives; The cycle begins with homeostasis, andmoves to a sensation of some kind. This leads to awareness of need and a clarification ofthe need. At this point, energy and excitement are generated as the need is on the verge ofbeing met. The individual scans the environment, sees a way to meet the current need,takes the action necessary to meet the need, makes the necessary contact, and then attainsclosure (Frew, 2004). This can be as simple as perceiving thirst, getting the waternecessary to quench the thirst and returning to one's activities. But, in psychotherapy, thiscycle is more complicated and necessitates help from the Gestalt therapist to increaseclient awareness so the client can cycle through a painful place which was previouslyout of awareness. The following vignette may help to illustrate how this cycle worksclinically:

Liza, a 24 year old Caucasian female, presented to therapy with many relationshipissues and ambivalence about her current boyfriend. Her therapist asked her to close hereyes and attempt to convey what her physical sensations were at the moment. Though atfirst she denied any sensations in particular (homeostasis), she then stated that her chest

23


31/59

felt like t had a band around it (sensation) and the sensation was very anxiety producing(awareness). When questioned about the anxiety, she stated that she was afraid that her

boyfriend's needs would smother her and make her crazy (clarification of the figure).The therapist encouraged expression of these feelings, and had the client talk to thetherapist as if she were the boyfriend (scans the environment and take action). After aseveral minute emotionally-charged tirade, ending with the statement I don't know if Ican give you what you want (contact) the client relaxed, and stated that her chest nolonger felt tight (closure).

Boundary PhenomenaThe cycle just ~ s c r i e d is present in multiple ways in our activities of daily

living, as well as in our emotional processes. Many different roadblocks exist that serveto short-circuit the cycle of organismic self-regulation, and need to be defined andunderstood to complete this overview of Gestalt psychotherapy. An interruption at anypoint in the cycle creates the need to make a creative adjustment to the person's reality.Creative adjustments are ways that human beings compensate for the difficulties of theirlives and circumstances, and though they provide survival and function, they may limitthe experience of the self, flexibility, and ways of being with others. When disturbancesexist in perceiving, experiencing, identifying with, and acting on needs, this loss offunctioning is observable by the trained therapist at the contact boundary, which refers tothe dynamic relationship at the point where the person and the environment meet and act(Zahm Gold, 2002, p 867). Gestalt therapy focuses on the contact boundary betweenthe individual and the environment, and how the client negotiates relationships. Mackewngoes on to say,

24


32/59

For it is here that client and counselor can notice the patterns of howpeople connect (or fail to connect) to their surroundings and circumstancesand thus learn about how they meet (or fail to meet) their needs. A fixedgestalt involves denying or displacing a human need and requires effortand energy, even though the active effort, like the original need, is keptout of awareness (Mackewn, 1997, p 27).

This can happen in many different ways, as defined below, and at times, thesemechanisms can be connected. These processes are out of the client's awareness andshow how contact can be disrupted at any point in the cycle. It is important to point outthat in non-pathologizing Gestalt style, that these interruptions of contact may also bedefined as dimensions or styles of contact that help an individual organize their field.Depending on the circumstances present in the field, these boundary phenomena maydisturb or support contact, depending on what is taking place in the individual field(Mackewn, 1997). he concern of the Gestalt therapist is on where in the cycle theseinterruptions take place, and how they impact the client's interactions in the world.Disruptions o ontact

Introjection has been described as something in the individual's environment thathas been swallowed whole with no time taken to chew , and make it authentically partof the self (Zahm Gold, 2002). When a person introjects, they take in an idea or valuewithout any examination, evaluation, or assimilation. t is simply taken in whole, andbecomes part of the self. An introject can be anything from a negative statement a parentcontinually makes ( you are no good and lazy ) to an idea we get about ourselves fromour environment (I am no good unless I am producing something of value). Introjects canbe damaging not only to our concept of who we are, they can also serve to disrupt ourability to form relationships that are mutually satisfying.

25


33/59

Projection is defined much as it is by psychoanalytic theory- a disowning of abehavior, trait, or an emotion in the self and then projecting it on to a person or onto the

environment. f a person has introjected the idea that she must not be angry, she mayproject the emotion of anger upon a person outside herself, accusing them of being angry.This shows the interconnectedness of the various contact disturbances, specifically howan introject informs and creates a projection. Projections serve to keep the emotions ofthe client out of awareness, and mistakenly attributed to others.

Retroflection occurs when some action that could be taken toward theenvironment cycles back to the individual instead. There are two types of retroflectirig. Inthe first type, an emotion that an individual feels is unacceptable to express possibly theresult of an introject) and is instead turned back on the person anger at the self instead ofthe person we are truly angry with). In the second type, an individual does for him orherself something that the environment could potentially provide comforting ourselvesrather that getting comfort and support from the environment), perhaps stemming from anintroject involving our self-worth. An example of this could be a person who rubs theirown neck in a room full of massage therapists.

Confluence is defined as denying the existence of boundaries between the self andothers, or between the self and the environment. This can be a satisfying state in momentsof intimacy with another person, but as a steady diet, it denies the person a firm sense ofself and individuality. e can see why it might be comfortable for an individual who hasperhaps introjected the idea that they are worth nothing unless they are connected toothers or a person who does not feel safe in the world unless they are permanentlybonded to another human being. However, this contact interruption serves to cripple the

6


34/59

self emotionally, and creates dependence in relationships, rather than a healthyinterdependence.

Deflection provides individuals with a way of reducing the intensity of contactwith others. Literally, it is when one pushes aside or avoids contact when it feels toointense or direct for an individual. It may manifest as poor eye contact, aloof bodyposture, or joking when contact with another person feels too intense. Deflection can behelpful under certain circumstances, as can all these styles of contact, but too much of

any of these m y disrupt or short-circuit meaningful relationships and contact with theworld.

Conclusion to Overview of Gestalt SectionGestalt therapy principles are informed by the stance that human beings do the

best that they can with what their environments hand them. Making creative adjustments,varying contact styles, and keeping painful issues out of their awareness serves to protectindividuals and often keeps them reasonably functional in their everyday lives. Gestalttherapy wants to help troubled individuals increase their awareness of whatever is figuralin their field, and fully embrace the essence of who they truly are. Then, utilizing theparadoxical theory of change, they m y use their heightened self-awareness to move

forward in their lives to more satisfying relationships with themselves and others. Gestalttherapy is focused on creative solutions, not on pathology. It strives to respect thephenomenology of the individual, creating an I-Thou relationship that is in itself,inherently healing.

7


35/59

RELATIONAL ASPECTS O INTERSUBJECTIVITY THERAPY AND GESTALTTHERAPY

As illustrated in the previous sections, both intersubjectivity theory and Gestalttheory have many relational aspects, intersubjectivity being relational by definition, andGestalt therapy having evolved since its inception to a more relational stance. Beforedelving further into relational aspects of both theories, it is necessary to differentiate trueGestalt therapy from what has been termed Perlism , which is best defined as theoutrageous, provocative style of Fritz Peds in the 1960's This type of therapy did notalways attune itself to the therapeutic relationship, and was indeed sometimestraumatizing (Mackewn, 1997). Contemporary, integrative Gestalt therapy is not, atheart, a matter of developing new tricks and techniques but of creatively adapting theapproach and the practitioner to meet the other person or people where they are availablefor meeting (Mackewn, 1997, p.viii). This approach mirrors the intersubjective approachin that the therapist desires to understand the client's subjective reality and meet the clientprecisely where they are as they seek psychological help. Both theories use many of the

same conceptual building blocks, philosophically and in application, though the termsused may be different. Several important shared relational aspects of the two theoriesfollow.

28


36/59

TransferenceBoth theories acknowledge and use the concept o the transference, though they

define it in slightly different ways. Traditional psychoanalytic theory defined transferences an attempt o the patient to the analyst to revive and re-enact, in the analytic situation

and in relation to the analyst, situations and phantasies o his childhood. Hence,transference is a regressive process (Waelder, 1956, p.367). Defined this way,transference was connected to unconscious drives, and an archeological perspective on

the part of the client. The client needed to relive past relationships with important earlyobjects as a way o reenacting past trauma or unsatisfactory relationships, and this wasseen as a distortion of reality. In intersubjectivity therapy, the concept o transference hasevolved, and is conceptualized somewhat differently. Stolorow defines it thus:

Transference in its essence refers neither to regression, displacement,projection, nor distortion, but rather to the assimilation o the analyticrelationship into the thematic structures o the patient's personalsubjective world. Thus conceived, transference is an expression o theuniversal psychological striving to organize experience and createmeanings (Stolorow et aI., 1987, pp. 45-46).

Defined as such, intersubjectively oriented transference utilizes the significance o theclient's relationships and what meanings the client makes from those relationships. It isnot about remaking or reliving the past, but rather about understanding presentrelationships in light of past relationships and what organized those past relationships.Previous psychological themes from the client's life are used to make sense o presentrelationship, particularly the dynamic relationship with the therapist. t is about how pastexperience is organized and meanings created (Buirski Haglund, 2001).Transference in estalt Therapy

29


37/59

anytherapists incorrectly assume that Gestalt therapy does not acknowledge theconcept of transference. n fact, early Gestalt theorists had many issues with the Freudian

concept of transference, particularly the over-emphasis on the transference relationshipbetween therapist and client and on the interpretation of that transference as the primarymode of psychotherapy. However, Gestalt therapy has always acknowledged and usedthe concept of transference, and Peds contributed to the field pf psychotherapy bypositing that the therapist could accept the client's transferential feelings as valid inthemselves (rather than the Freudian distortion of reality ) and could respond to themauthentically (Mackewn, 1997). Much like intersubjectivity theory, Gestalt theory viewsthe transference as the way clients perceive their current reality,

through the lens of their history, their unfinished business, their fixedgestalts rather than merely according to the properties of the currentsituation. t is the process by which people assimilate their present lifeexperience (including the experience of counseling) into their establishedpatterns of organizing and making meaning of their field. In other wordstransference is one way (often a habitual and fixed way) of organizing thefield (Mackewn, 1997, p. 93).

Thus, much as intersubjectivity defines it, transference in Gestalt therapy organizesexperience and makes meanings of that experience. Both theories see transference asconcerning relationships, patterns in relationships, and the possibility of using thetherapeutic relationship to begin to experience relationships differently. Both theories usethe relationship and how the client contacts/connects to understand the client 's subjectivereality (intersubjective theory) or their phenomenology and how they negotiate thecontact boundary (Gestalt theory). This leads to the concept of dialogue, an importantelement in any relational therapy, and one that is paramount both to Gestalt andintersubjectivity therapies.

30


38/59

DialogueBecause intersubjective therapy strives to understand the client's subjective

reality more than anything else, it is primarily dialogic in nature. Dialogue provides ameans o exploring and understanding the client's subjective reality, and the chance tothen be accurately attuned to what the client feels and needs. In this way, the therapistmay provide the sustained empathic inquiry that is the cornerstone o intersubjectivelyoriented psychotherapy. The therapist works with whatever is salient to the client at thepresent moment, and in this way will uncover what needs to be revealed as the therapyprogresses. We keep the dialogic ball in the air by attuning to the patient's affectiveexperience, not by collecting data (Buirski Haglund, 2001, p.108). An importantaspect o intersubjective dialogue is the ability on the part o the therapist to accuratelyarticulate the client 's emotional experience. This is the difference between asking theclient how did that feel to you? and accurately stating you felt crushed . Byarticulating the patient's subjective state, the therapist conveys an experience o bothacceptance and understanding (Buirski Haglund, 2001, pp. 107). This reinforces theintersubjective focus on the relationship between client and therapist. The client's feelingthat the therapist gets it can be enormously powerful and healing for a person who hasfelt misunderstood and judged for much o their life. This relational emphasis on dialogueprovides the impetus for connection between client and therapist, facilitating deeperexploration o the past and how it impacts the present.

ialogue in Gestalt TherapyDialogue provides an important cornerstone to Gestalt therapy as well, though

again, it is conceptualized in a slightly different way. In Gestalt therapy, the importance

3


39/59

of dialogue stems from the influence of the philosopher and educator Martin Buber, whowas particularly attuned to the breakdown of interpersonal relationships in 20th centuryculture. His book, I nd Thou gave voice to the idea of genuinely encountering oneanother as fellow human beings. The I-Thou relationship is genuinely interested in theother, and Gestalt therapy adapted this philosophical perspective to inform the conduct ofGestalt psychotherapy. To see and hear the other as a genuine person, and respond assuch provides a healing through meeting moment in Gestalt therapy (Hycner, 1988).Hycner and Jacobs (1995) point out that there are many misunderstandings of what.wemean when we say we want to work dialogically in Gestalt therapy. They first point outthat diaologic therapy is primarily an approach, rather than a technique. It placesJherelational at the heart of our existence and of our work as therapists (Hycner Jacobs,1995, p.91). They further clarify that dialogical therapy contains both I-Thou momentsand I-It moments. The I-Thou moment that is central to Gestalt therapy is not a thing weseek, but rather a moment or moments of grace in which we authentically encounter theother, and hopefully expand client awareness. The dialogical requires a rhythmicalternation ofI Thou and I-It connectedness (Hycner Jacobs, 1995, p.92).

This emphasis on genuine encounter through dialogue provides an emphasis onthe interpersonal connectedness between therapist and client. In this connection, therapistand client both contribute to the dialogue, and experience moments of connection andunderstanding. Mackewn expands on this idea stating that,

Dialogic relating, together with the process of relating (or contacting), is atthe heart of Gestalt counseling and therapy. It provides the medium for thegrowth of awareness, learning, problem-solving, and self development.Your relationship with clients is not ancillary to the therapeutic counselingprocess but central to it. Dialogic relating can- and does- take place insilence, laughter or playas much as in words (Mackewn, 1997, p.80).

32


40/59

Dialogue in both theories takes place in the larger context of the intersubjective fieldthe concept to e addressed next.


41/59

The Intersubjective FieldFinally, an examination of how each theory addresses the concept of the field

follows. The concept of the field is a relational aspect of both theories that encompassesthe other two relational aspects just discussed. Intersubjectivity theory examines and usesthe field to accurately view the two subjectivities in the system they create and fromwhich they emerge- in any form of psychoanalytic treatment. Because of this focus,intersubJective theory also implies a contextualist view of development and of

pathogenesis (Orange, Atwood, and Stolorow, 1997, p.3). The emphasis on context issalient because intersubjectivity theory strives to understand the unique subjectiveexperience of the client in order to provide accurate empathy and attunement.

Unlike other systems of psychotherapy, intersubjectivity theory acknowledgestwo subjective realties (client and therapist) and focuses on the interplay between those

two subjective realities. We cannot work within the intersubjective field andsimultaneously step outside the field to describe it. .. from a God s eye view (Orange, etal., 1997, p.4). Rather, the intersubjective therapist remains in the field with the client,knowing that the two subjectivities work together to make sense of the client'sexperiences and meanings. Thus, the intersubjective therapist uses the field to work withthe client in a relational way, examining instances of transference and using a dialogicsensibility to make meaningful contact with the client. The intersubjective field of theanalysis, made possible by the emotional availability of both analyst and patient, becomesa developmental second chance for the patient (Orange, 1995, p.S6).

34


42/59

Gestalt ield TheoryGestalt therapy emphasizes the field in a different way, using a philosophically

based field phenomenology to understand their clients and increase awareness. As statedin the Gestalt theory section, it is comprised of the totality of all that is internal andexternal of the self. Like intersubjectivity theory, Gestalt theory acknowledges that thefield is impacted by both the therapist and client, which again reinforces the relational,interpersonal nature of both theories. t is comprised of foreground and background, and

is inherently dynamic. Within this field the dialogue takes place, and is where the

Documents

Relational Aspects of Intersubjectivity Therapy and Gestalt Thera