Therapeutic Methodology

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Therapeutic Methodology

The following are excerpts from dialogue on the AAGT mailing list, and / or short descriptions on an

issue involving the application of theory. People are encouraged to contact others interested in Gestalt by

bringing their responses to these, and other issues, to the Gestalt community via email.

Send a message to the list ([email protected]).

This section will fluctuate to reflect the changing figures among the AAGT community as they

appear in dialogue on the mailing list.

1. Paradoxical Change

2. Here-and-Now Transference

3. Phenomenological Method

4. Psychodrama and Gestalt therapy

Paradoxical Change

"People often change in spite of themselves.""Good things happen on ordinary days."

"All that is in therapy does not take place within the parameters of the office visit."

These observations hint at the dynamic of paradoxical change. In contrast to therapeutic approaches that

target specific behavioral goals and identify dates by which these goals should be accomplished, often

seeking to observe some manifistation of it within the therapeutic hour, Gestalt seeks for contact andawareness, letting the goals of change occur outside, experienced or observed by the client. While

therapists may notice that something is different, they do so after the fact. This is a decided difference,

and often requires a Gestalt therapist to translate his or her process into more palatable terms for the

benefit of third-party payers. However, for many Gestalt practitioners this is one of the reasons they do

not bother courting third-party reimbursment at all.

Change may also occur in front of one, indeed, within the therapeutic hour. The paradoxical does not onlyrelate to the consideration of time, but also of the quality or character of the process. Change occurs,

movement takes place, insight springs forth, but it happens uninvitedly; it drops in one one by surprise,

and that is what seems paradoxical - almost as if one were purposely tring to avoid such change and justconcentrate on what actually is, at the moment.

Here-and-Now Transference

"My question is: what does the present-centered, contact-oriented, gestalt approach offer this sub-group

of projections (transference and countertransference) that more traditional models do not address?"

-Morgan Goodlander (1996a)

"...I hope you'll say how you determine when a client's reaction to you is transferential and when it is an

honest reaction to you yourself...

...how can you tell if your reaction to a client is counter-transference and when it's an honest human

response? One of the major tenets of Gestalt therapy is that the experience of therapy is 'real experience,'not just referring to other people in other times and in other places." -Sylvia

Crocker, Ph.D. (1996)

"One of the first things I do when I notice a client is beginning to project a positive or negative

transference is to make sure I am aware of my full response to their behavior. Often this includes some

self disclosure that acknowledges whatever counter-transference may be occurring. My experience is that

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transference acknowledged as a natural part of the contact experience is empowering to the client because

it begins the process of reowning the projection directly in the context in which it occurred and is

empowering to the therapist because it allows s/he to stay fully in touch with their experience, hopefully,

providing less opportunity for disowned projection to influence the work later." -Morgan Goodlander

(1996b)

"From Isadore I understood that transference was transferring...that it is a 'here and now' experience (as iscounter-transferring) and as such allows us GT to attend to the HOW this is happening...I rarely use an

empty chair or pillow - not wanting to possibly deflect from the client's potential impact on me. I want to

allow for the 'fullest meeting' possible and to remain as open, vulnerable and aware as possible - that I

might know what THIS experience of self/other is like...In fact, I have been on something of a crusade

these many years to remind folks that GT is a PROCESS therapy, and that it behooves us to think and talk

of it that way, so that for example, projection becomes projecting, introjection = introjecting, and so on.Verbs rather than nouns. It is my experience that when I do this, I am forced to stay in the present,

meaningful contact rather than move into more abstract, labeling and thinking (retroflecting)." -Maya

Brand (1996)

"Fritz did us no favors in the mid-60's when he characterized transference as "a lovely game..." Although

this resonated with the popular culture, it diminished our credibility with more established schools of

psychotherapy and I believe it was a reflection of an adolescent stage of Gestalt theory development. This

is not a vendetta against the theory or against Fritz. I am claiming that we have made great technicalstrides since that time, as has our abilities to integrate other psychotherapeutic concepts, including

transference...

...Otto Rank's conception of transference as the means whereby the client demonstrates their past, fits

well into my conception of unfinished gestalten and emerging figure. Interruptions to contact protect us

from the full awareness of the unfinished business of relational needs. When these are not met, the

organism has to cope. This coping is the definition of resistance offered by Laura Perls: the organism's

desperate attempt to assert it's integrity...

The client is telling a story and expressing intrapsychic conflict. The organism is demonstratingdevelopmental needs which have been thwarted, and the boundary processes which were ingeniously

developed in the absence of an environment which could provide those developmental needs. Through

ongoing contact (dialogue, touch, a developing history, etc.), the client gains a new reference fororganizing experiences and creating meaning as the unfinished gestalten emerge in the context of 'the safe

emergency.'

It is the safety of the therapeutic relationship that is my primary tool for creating the safe emergency. As

the transference (the story of unfinished developmental needs) unfolds my task is to be a vessel whichcontains and supports the process. As the client shuffles between present external awareness and

unfinished business emerging in the present, I will either provide the 'necessary and sufficient' support for

completion or I will be the container for the client's juxtaposition of affect as he/she realizes a history

which is incongruous with the one originally constructed to compensate for an impoverished

environment. There is only one place, of course, where all of this occurs: in the moment!"

-Charlie Bowman, President of the AAGT (1996).

"...clients, even though there are elements of transference, are making contact in the only way they knowhow. And if that contact is diminished (in our eyes) our job is to stay in the room with them where they

are at the moment and help them become aware of the possibility of other choices."-Todd Butler (1996)

_______

In many ways gestalt psychotherapy can be conceived of as the process of ameliorating the healthy

contact between a person and his or her environment, with a view to satisying of needs.

"For Perls the analytic situation evoked in the patient a present need or opportunity, which

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could be pursued without reference to the past...What the psychoanalyst terms transference

is conceptualized and referred to as a contact boundary disturbance by the Gestalt

therapist. In psychoanalysis the transference will ultimately assist the patient to understand

past relationships. In Gestalt therapy the boundary disturbance indicates that the patient's

awareness is impaired in the present contact with the therapist." (Frew, 1990, p. 195)

The therapeutic goal is the resumption of growth by means of bringing the individual into closer contactwith and greater awareness of the present. To be more aware in the present moment means risking clear,

unobstructed contact. At the individual level, an observation could be made about a person's breathing or

their physical posture. At the interpersonal level a suggestion could be made to express what one is

experiencing after hearing another speak. In groups the leader might ask about the extent to which a

person's remarks about someone else represent the attitude of the whole group, or in individual work, the

therapist could self-disclose his or her response to the transference and/or relate their own counter-transference. It should be remembered that transference is a sub-set of that form of boundary disturbance

known as projection. Projection has a healthy, positive side as well, for by means of projection we're able

to empathize with a friend, identify with another person's situation, or understand someone else.

Projection can also be used to deny experience and pretend that it resides in someone else.

"Through projection, individuals perceive the world in their own images and distort

perceptions of people or events in accordance with their beliefs, attitudes, or emotions.

When they perceive what they want to perceive instead of what is really there, they areprojecting...

...The Gestalt therapy position is phenomenolgical: each person construes and constructs a

personal life world that is unique. Each person functions in the world on the basis of

observations about which ideas, assumptions, or fantasies are constructed. No person can

know how the world is for anone else; one can only use one's projective imagination to

construe it. The healthy position is to make clear observations as to what is perceived to be

going on, to recognize and accept responsibility for the observations, to be aware of

projecting, and to be receptive to new information. Projection without awareness,

responsibility, and receptivity to new information leads to the denial of important sensoryinformation, replacing that information with one's own idea or fantasies." (Korb, Gorell, &

Van De Riet, p. 57-8)

Phenomenological Method

In keeping with the phenomenological method, the Gestalt therapist will focus on the actual experience of

the client. The relationship between the therapist and the client is included as part of the focus. The

Gestalt therapist is taught to "bracket off" his interpretations and hypotheses in order not to impose his

version of reality onto the client. From this method, the client's awareness may develop undebauched by

"shoulds" or other imposed beliefs of the therapist or society.

Awareness is both the primary method and the goal of Gestalt therapy's phenomenological approach.

Phenomenologically enhanced awareness endows clients with better tools for understanding themselves,their place in the world, and how they create this place. Clients are taught that the lives they create and

maintain for themselves is their responsibility; hence, it becomes their responsibility for changing.

Gestalt therapy provides its practitioners with a rich array of methods and techniques for the

phenomenological enhancement and the exploration of awareness. Almost all methods are are centered

around a "here and now" and a "what and how" approach. The what and how of experience assists clients

in their current, immediate experience of being-in-the-world. In this way, clients can more easily be

aware of their experience of what they are doing literally, in the present. Gestalt therapist's questions,"What are you doing right now?" or "How do you know that?" reflects the belief in the importance of

present experience and demonstrates our ahistoric and non-interpretive stance.

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How one becomes aware is explored as well awareness itself by the phenomenological oriented Gestalt

therapist. So we study the awareness process and awareness itself. As part of this study, the relationship

between the therapist and the client is explored both dialogically and experimentally.

The Gestalt therapist respects each client's experience of reality as accurate for that client. The dictum,"What is, is," typifies our phenomenological stance.

Psychodrama and Gestalt therapy

The following are selections from a dialogue on the AAGT list in which various people offered

stimulating persepective enjoyed by all involved. These portions of that interaction have been reproduced

with gratitude.

"I agree with what is being said about psychodrama and trained in psychodrama myself for 3 years before

engaging in full-time training in gestalt. I found the ground of psychodrama, particularly sociometry, has

helped me in seeing the group as a living organism and in working with the group organism in the same

way as I would with an individual.

I also think though that psychodrama, while rich in particular types of practice or experiment does not

have the richness of theory and philosophy of gestalt, which for psychodrama leads to a rather frozenfixed ground of practice, where the process of group and individual is more proscribed through role

theory and stages of group process, while in gestalt, as a result of a wider philosophical ground,

experiment and practice is unlimited and more flexible.... ie in Bob Resnick terms, from his interview

with Malcolm Parlett, Gestalt can incorporate psychodrama into it's field while, psychodrama needs to

expand to incorporate gestalt.I agree with what is being said about psychodrama and trained in

psychodrama myself for 3 years before engaging in full-time training in gestalt. I found the ground ofpsychodrama, particularly sociometry, has helped me in seeing the group as a living organism and in

working with the group organism in the same way as I would with an individual.

I also think though that psychodrama, while rich in particular types of practice or experiment does not

have the richness of theory and philosophy of gestalt, which for psychodrama leads to a rather frozen

fixed ground of practice, where the process of group and individual is more proscribed through role

theory and stages of group process, while in gestalt, as a result of a wider philosophical ground,

experiment and practice is unlimited and more flexible.... ie in Bob Resnick terms, from his interviewwith Malcolm Parlett, Gestalt can incorporate psychodrama into it's field while, psychodrama needs to

expand to incorporate gestalt."--Brian O'Neill, 1996

"It seems to me that Psychodrama is relegated to a realm of method and Gestalt is relegated to a higher

order of integrated theory-philosophy-technique. I am positive this is not the view of a passionate Trainer

Educator Practitioner of Psychodrama and Sociometry. Could our tendency to capitolize the G in Gestalt

and use the smaller case p in psychodrama hint at some level of arrogance on our part? I will certainly

own my arrogance in my belief that Gestalt therapy is numero uno!

I studied psychodrama for a year or so intensely with John Nolte and Roy Ford while deciding whether toleap into it or to devote my time to Gestalt therapy (in Indianapolis we have the Indianapolis Gestalt

Institute and the Midwest Center for Psychodrama and Sociometry). Roy and I had daily contact and

wonderful debate on the merits and pitfalls of the two theories/techniques, and I co-facilitated apsychodrama group with him and he a Gestalt group with me. The differences seem to me to be similar to

the differences between Portugese and New World Spainish: while both have roots traceable to the same

origin, there would probably be little understanding of meaning in the dialogue!

We avoid 'contaminating' the work with the others 'stuff'. Psychodrama Directors trust in Tele andprocess when alter egos are selected--believing the "stuff" will ultimately serve the same purpose. This

and other differences aren't differences in technique, they are fundamental differences in our views of the

therapeutic process. My many discussions with Roy clarified that for me. My experience with

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Psychodrama people, as with Gestalt people, is that the course of study for either is rigorous, requiring

much study and personal involvement. The process of making meaning of the experience of 'contact' for a

Gestalt trainee/trainer is no different than the process of making meaning of 'drama' for a Psychodrama

trainee/trainer." --Charlie Bowman, 1996

"I have been interested in the discusssion about Gestalt therapy and psychodrama, Perls and Moreno,etc. I

am in agreement with the observation that at times both approaches look alike. The key here, in myopinion, is why Gestalt therapists do what they do and why psychodramatist do what they do. . I suspect

that on this dimension we are different.

Isadore From has cautioned against the use of techniques that produce drama (high drama at times!)and in

the particular case that From was talking about does not dissolve projections. Isadore From went on to

say in his elegant fashion (here I am paraphrasing)--if it is not 'contact making' what is a Gestalt therapistusing a technique for?

The abuses of techniques, whether it be one borrowed from psychodrama or any other Gestalt therapy

technique, occurs when the purpose is forgotten. That is, to assist the client/patient in contact making

and/or to enhance awareness.

A difference I have noted in my limited exposure to psychodrama is that other people from the group may

be involved in a particular drama, representing different people in the patients life. Whereas, in Gestalttherapy the patient usually is asked to "become" these significant people. I prefer the latter approach

because I think we get to the patient's introjections and projections without the contamination of askinganother person to participate. But whatever appoach one prefers, one key is what is done after the drama,

e.g., is there any integration. And is there 'contact making' between the therapist and the patient, or is

there contact making between the patient and the other group members." --Bob Harman, 1996

"...I use psychodramatic elements, whether individually (as in the case I described) or in group work, it is

just another way of doing Gestalt. I agree with everything you said about the problems with Moreno's

psychodrama, and with From's points about contact and awareness. In the case I described, my having her

talk TO her father, heightened the therapeutic contact she had with him and with herself; and when sheactually dealt with him in new ways her contact was wholly congruent--for the first time--with the way

she felt internally. The quality of the contact in therapy prepared her for the subsequent contact, and the

use of imagination in therapy sharpened both kinds of experiences.

I think Isadore was too narrow for the good of the development of the Gestalt approach. He mistakenly

thought that everything of significance had already been said, or so it seems was his position. I do agree

with him, and with you, that it is a mistake simply to tack on other techniques to Gestalt therapy without

doing them for Gestalt-theoretical reasons. Nor do I think it is ever necessary merely to tack on otherpowerful methods without doing so for reasons which are grounded in Gestalt therapy's theory. I believe

that the task of developing Gestalt methods is to understand the reason why they are to be used, always to

increase awareness or facilitate good contact (including action). Our theory is broad and rich enough to

permit us always--with thoughtful effort-- to understand other powerful techniques in our own terms, and

to use them for our own Gestalt reasons. This is one of the ways in which Gestalt therapy can and will

continue to develop and to spread its influence.

I learned the Gestalt-psychodrama blend from Leon Fine, who was from Portland, Or. He had studiedwith Fritz and Laura, and with the psychodrama people; he trained people primarily in psychodrama, but

when he trained in Gestalt he used the blend. I had workshops with him both in Gestalt and inpsychodrama. I think his group work was unsurpassed, at least in my experience. Instead of having other

people from the group try (as in psychodrama) to improvise someone's mother, father, and husband, for

example, he asked the person to choose individuals from the group to play these parts, but they never did

any improvisations. Rather, they were people who were spoken directly to by the person who was

working; then when it was time to have the other person, for example the mother, speak, Leon had the

two change places, with the group member playing the part of the client and giving the last sentence as a

cue, while taking on the body posture, the voice tone, and general affect of the client. So when, for

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example, the client was playing her mother she could play off the actual presence of someone who was

imitating her as she had revealed herself to be prior to reversing roles.

This allows the client to see vividly how she reacts when she is dealing with her mother. The same thing

happens whenever the client has a fantasied dialogue with anyone in the piece of work. Thus there was nocontamination by other's stuff, as there is bound to be in classical psychodrama.

The therapist can also do some powerful things as the work progresses. For example, if a client's parents'

message was perceived by her to have been: "We expect great things from you, but you'll never amount

to a damn thing" ( this would have come out earlier), the therapist can heighten the intensity of the

contact--and perhaps help the client to become more fully aware of the futility of continuing to try to

please these people--by having the group members playing the father and mother repeat this message in

unison to the client no matter how the client tries to win them over, and no matter what she says to them.Projections and introjections are readily dealt with by this method. Also, space can be used more

realistically, since the individuals involved can act out in space some significant scene. On the whole, this

method is more realistic and vivid than empty chair work in a group setting, and certainly more so than

merely talking ABOUT the significant people the client has issues with.

After the work is finished there is the same opportunity for sharing as in other forms of group work. Also,

if one or more persons in the group is chosen repeatedly to play the same kinds of roles as the group goes

on over time, these persons can notice and share how it is for them to be so chosen; also this provides anopportunity for them to learn something of how they come across to others.

When I did a presentation of this method at a Gestalt Conference some years ago, Richard Kitzler said it

was the first time in years he had seen anything new which was "pure Gestalt". I think this method is an

instance of using techniques from another approach for Gestalt reasons. I think it's a powerful method,

and I also think it makes group work more involving and interesting for all of the members of the group...

--Sylvia Crocker, 1996

...I think (like many other approaches) its not in the public eye so much these days as it was in the past,

but it has influenced a lot of practice--especially in subtance abuse treatment programs. Also, I can seevestiges of psychodrama in such 'new' techniques as 'family sculpting'. Actually, I feel freer to be creative

when 'doing' psychodrama than I do when 'doing' gestalt (as a counselor educator, I do a lot of

demonstrations and workshops) although I have had more training in gestalt. I don't know what that'sabout for me--maybe the 'structure' in psychodrama helps with that. I know that the folks I have trained

with in psychodrama were quite willing to 'experiment' in the gestalt sense with a variety of (I don't want

to say techniques so I'll say) ideas about how to recreate a client's experience. I think the two

methodologies complement each other and bring richness to the work.

As for the theoretical differences, I never understood Moreno's writings well enough to have a broad

understanding of his rationale for what he did--except to understand that Moreno felt that 'talking about' a

problem did not bring change--only action would. For me, what brings momentum to the change process

is awareness and what creates awareness is experiencing my process in all areas of my life. Psychodrama,

for me, brings the dimension of recreating the 'experience' , which then allows for awareness to occur..."--

Martha McBride, 1996

"...I'm much more interested in the therapeutic use of a person's imagination than I am in psychodrama.Maya pointed out that what I had described as my work with one of my clients was taken from

psychodrama (while Iris Fodor pointed out that it was behavioral therapy!). I don't want let the subject ofthe therapeutic use of imagination get lost in the discussion of psychodrama.

When Perls borrowed from Moreno the use of a person's imagination in the service of therapy I think he

simply extended Gestalt therapy's methods, without doing any damage to its theory. Most of the issues

which bring people into therapy have to do with people and situations outside of the therapeutic situation.

Through the therapeutic use of imagination, we can make explicit the psychological presence of the

significant others in the client's life, and the client can work through numerous issues in the here and now,

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which is one of the hallmarks of Gestalt therapy. In a significant sense these others are already present

when the client comes to the therapist, insofar as their influence has been internalized by the client.

If the client and therapist only talk ABOUT these others, rather than having the client talk TO them, then

a great of knowledge that the client has about these others and the situations involving them remainsinaccessible. Additionally, the stories the client tells about these others is far more under the control of

the client than they are when the client "hallucinates" the others, playing both his own part and that of theothers. The actual experience of the shift from mere talking to imagination is clearly different, both

emotionally and physically. Client's register this difference as soon as they are asked to make the shift, or

as any of you know from your own experience of role playing.

The following is an amusing example of the power of imagination to make accessible important

knowledge which the client has had all along. I once had a client whose husband's business frequentlymade it necessary for him to drive over a mountain pass in the winter. For years she had begged him to

call her when he got to his destination, but he always refused; and it continued to be a source of conflict

between them. I had her speak to him in fantasy about the situation. She said, "I know why you won't call

me. You're scared you won't make it, and you just don't want me to see that you're scared." When she

reversed roles, her tone of voice changed, she (playing the husband) registered a look of utter shock and

amazement as she replied, "That thought never entered my mind! You just worry about everything all the

time, and I'm not going to go along with it!" When she reversed to her own role again, she sheepishly

said, "You're right." And it was never an issue again. Our clients know a great more about the significantothers and the situations in their lives than they know they know. By accessing their power of

imagination in therapy, they frequently gain access to this information. Mere talk about these mattersdoes not usually have this effect.

By using only the dialogic method, we can see in therapy many of the ways in which a person interrupts

and distorts his contact, we can work with polarities and other conflicts, we can work with introjects and

other beliefs, and so on. This is an enormously valuable method, and I believe it is a limited method. For

one thing, the content is still too open to unintentional censorship by the client; imagination lessens this

considerably. For another thing, the transference of the learnings in therapy to the client's everyday life is

somewhat problematic when they are acquired in the safety of the therapeutic situation. But when aperson speaks directly to the imagined others, the emotional tension of the everyday life situation is

somewhat replicated, and the learnings immediately begin to connect with those situations outside of

therapy.

Gestalt has always put itself out as more than a "talking cure". The use of experiments, including but not

limited to those using imagination, are what distinguishes it from "talking cures". I think that even though

dialogue is profoundly important, as a pure method it is limited, as all talking is limited in its power to

bring about change. Even when we add to it the dynamics of the relationship, we still have a limitedmethod, since most of the issues transcend the relationship with the therapist, and will never be replicated

with the therapist. The idea that they can be is, in my opinion, a major fallacy in psychonalysis." --Sylvia

Crocker, 1996

"Well, I agree with most of what you said, but I still have a problem with your use of the term

'imagination'. For me, that term limits the scope of what can and does happen during 'experiments'. The

term 'imagination' also limits the preciseness of the intent of any experiment. For example, the intent of

split-chair dialogue is different from that of the 'empty chair'. The intent of other experiments may also bedifferent although fantasy may be used.

My problem with all of this (and it is my problem) is that I get concerned when therapists (and

theoreticians) begin using different terms that diverge from the original source of the concept. Perls did

not acknowledge his 'borrowing' from Moreno until his last book (that I'm aware of); Rogers did not

admit his debt to some the precursors of his approach and both Glasser and Ellis have used concepts and

ideas that were first pioneered by Alfred Adler while purporting to have developed something 'new'.

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Anyway,I must have experienced psychodrama training that was much more flexible and innovative than

some of the folks on this interest list. I have gotten many new ideas for 'experiments' from that training

and feel it helped my ability to be creative during individual or group sessions. I do love to use action-

oriented techniques as a part of my approach to gestalt therapy and feel that reenactments do help clients

both become more aware and integrated as well as more prepared to deal with the outside world."--Martha McBride, 1996

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Therapeutic Methodology

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