Written and published by Eléonore KEREUN, Charline RIFFAUD, Paloma LÉON and Kasianna PAGÈS
- INTRODUCTION
“The word ‘excitement’ is used to describe the energy people create. This life force ou élan vital is at the heart of the gestalt approach.” (Nelson-Jones, 2000). Actually, the gestalt therapy is based on the patient and his resources to become more aware of his inner life and focuses on the constant interaction of the human being with his environment. The Gestalt therapy movement emerged in the 1950s, led by Perls in opposition to psychoanalysis. Today it is well known and practiced throughout the western world. This sixth book chapter “Cas Approach to Gestalt Therapy” from Corey’s book (Corey, 2001) on which we focused, written in 2001 by Jon Frew, aims to introduce an illustration of the gestalt practice with the aftercare of a patient. The author, J. Frew has been training Gestalt therapists in the US and internationally for 35 years and is one of the Directors of Gestalt Therapy Training Center Northwest. The main point of this writing is to show the patient’s evolving throughout the sessions through action. She gradually moves towards a better knowledge of herself, her feelings, and her thoughts, focusing her attention on what she’s leaving moment-to-moment. The aim is to empower the patient to become an expert on herself.
- SUMMARY
This chapter of the book talks about Gestalt therapy, a noninterpretive therapy, giving us some theoretical elements but mainly based on a practical case to show how the theory can be applied in practice.
This chapter begins by outlining the main goals of the Gestalt approach. In this chapter, the author explains that experiencing the conflict directly is better than just talking about it. This kind of approach helps people to expand their own level of awareness of the problem and to better integrate the fragmented and unknown parts of their personality related to the problem. Subsequently, the chapter discusses the clinical posture of a Gestalt therapist, the therapeutic relationship as a collaborative one, the essential method of following the client’s current and ongoing experiences that are important for exploring their suffering, some of the techniques used in Gestalt therapy, and the timing of the completion of Gestalt therapy.
Then, through the case study of Ruth, the readers will be able to learn, through the therapeutic interventions between Ruth and her therapist, of certain the steps that constitute a Gestalt therapy such as the assessment that will allow to examine “the process that occurs as the individual interacts with the environment” (Corey, 2001, p.111), the establishment of a functional diagnosis, the identification of key issues and themes related to the client’s problems and the development of basic assumptions. In addition, certain therapeutic procedures with the primary goal of intensifying the experience of the here and now will be developed such as repeating aloud the thoughts that run through Ruth’s mind that she usually keeps to herself, the experience of inviting the client to replace “I feel guilty about…” with “I blame you for…” so that it helps her direct her anger to external sources where she needs to be rather than to herself, the therapist taking the place of a person to whom Ruth has things to say, the two-chair technique for working on certain divisions of personality, bringing a person to whom one needs to say things into the room and talking to him or her, the experience of “becoming” a bodily sensation and giving that part of one’s body a “voice,” etc. Through the many experiences, Ruth is thus able to discover for herself how certain past experiences are related to her current feeling of being blocked in many ways. This realization is, in itself, a powerful catalyst for her change.
The therapeutic interventions will be accompanied by explanatory comments on the expected Gestalt practice and the therapist’s posture to adopt. Indeed, the therapist, by inviting clients to experience new situations (e. g. try new ways of relating and responding), helps them to fully experience their being in the here and now by first realizing how they are preventing themselves from feeling and experiencing in the present. Then, by becoming fully aware of what is happening in and around them, they are being able to deal effectively with their life problems.
This book chapter will conclude with some final thoughts, questions to develop the readers’ thinking in relation to everything they have just read earlier in the chapter as well as notes to further their knowledge.
- CRITICAL EVALUATION
- DATE & DATA COLLECTION
In this article, qualitative data are used to illustrate the Gestalt therapy premises. Particularly, the data we have consists of a script of a clinical interview between a humanistic therapist and his client. In our opinion, this qualitative data is the best way to clinically illustrate how the therapist can bring the client into awareness of what he is thinking about and feeling emotionally or physically in the here and now. The sequence of lines allows us to become aware of how the therapist can naturally follow the client’s rhythm, staying as close as possible to the client’s words, i.e. without interpretation. By staying closer and closer to the client’s words, the client himself comes closer to his authentic thoughts, emotions and feelings and gets to the center of the problem.
- INNOVATION
One of the contributions of this chapter of the book is linked to the brief description it gives of Gestalt therapy in the first paragraph. Thus, starting the chapter of the book with this brief description allows readers to obtain basic theoretical elements on Gestalt therapy or to review them to reactivate certain knowledge in order to better apprehend the practical cases and have a better understanding. Thus, from the first lines, we are informed about the main objective of Gestalt therapy : “The goal of the Gestalt approach is to enhance awareness of here-and-now experiencing…The goal of Gestalt therapy is, quite simply, the restoration of awareness.” (Corey, 2001, pp.110-111), of the posture of a Gestalt-therapist : “Gestalt therapists seek a dialogue with their clients and employ experiments to sharpen and highlight their present and ongoing experiencing…Gestalt therapists are interested in the ongoing relationship between the individual and the environment…Gestalt therapists attempt to be fully present, convey to the client that they comprehend and accept the other’s experience, and vigilantly attend to the impact of each of their interventions” (Corey, 2001, pp.110-111) as well as of the role of experiences that arise from dialogue : “Out of this dialogue experiments are created that deepen clients’ exploration of what becomes salient for them” (Corey, 2001, p.110). Moreover, we obtain information on the theoretical foundation of Gestalt therapy : “Gestalt therapy is practiced with a theoretical foundation grounded in field theory, phenomenology, and dialogue” (Corey, 2001, p.110) and gives us detailed explanations on the concept of “phenomenology” : “Phenomenology involves seeking an understanding based on what is comprehensible through the senses rather than on interpretations or meanings defined objectively by the observer” (Corey, 2001, p.111). We also learn about the essential method of Gestalt which “involves following the aspects of the client’s experience of self and of environment that become figural or salient” (Corey, 2001, p.111).
Another contribution of this chapter of the book lies in the theoretical-clinical articulation that it allows us to realize through the reading of Ruth’s practical case. Indeed, the basic theoretical elements on Gestalt therapy at the beginning of the chapter are applied during the exchanges between Ruth and her therapist. Thus, thanks to this approach, we get many concrete clinical examples that illustrate different theoretical points and improve the understanding of the concepts explained theoretically. In this way, we can begin a learning process that gives an essential place to the theoretical-clinical articulation, allowing us to better approach the clinical experiences encountered in our practice by transposing this knowledge. For example, this chapter theoretically reminds us that the goal of Gestalt therapy : “is the restoration of awareness” (Corey, 2001, p.111) and thanks to the exchanges between Ruth and her therapist we will learn how in practice a gestalt therapist could accompany his client in the restoration of his consciousness : “I began the session by inviting Ruth to check in with herself as she talked about issues in her life. That intervention brings her into the present moment and brings her to the awareness that she rarely attends to her immediate experience. The next several interchanges follow a cycle of experience as Ruth identifies a sensation that leads to an awareness and a sense of excitement about what will happen next” (Corey, 2001, p.115). Moreover, this chapter provides us with concrete examples of experiences that Gestalt therapists can propose to their clients, thus providing therapeutic tools that can be applied in our clinical practice :
- “Some examples of experiments include creating a dialogue with conflicting parts of oneself…Here are a couple of chairs. I’d like you to sit in this chair here and be the proper side of you. Talk to the uninhibited side, which is sitting in this other chair” (Corey, 2001, pp.110-121).
- Another example of experience is related to : “Focusing on body messages…At different times I ask her to try the experiment of “becoming” her breaking heart (or any other bodily sensation) and giving that part of her body voice” (Corey, 2001, pp.110-122).
- We also find the example of the experience of :“reexperiencing past unfinished situations in the here and now…I ask her not merely to report what happened but also to bring her father into the room now and talk to him as she did as a child. She goes back to a past event and relives it” (Corey, 2001, pp.110-121).
- Some other examples of experiments include “exaggeration and working with dreams” (Corey, 2001, p.110).
However, this book chapter raises the question of scientificity. In effect, this book chapter is based on clinical practice and highlights the subjective experiences of a therapist supported by qualitative data from his sessions with one of his clients. At no point in the chapter are scientific sources cited, which may suggest that it is not based on scientifically validated evidence. Moreover, the author often speaks in the first person singular to illustrate his remarks, which reinforces the great part of subjectivity that there is in the experiences to the detriment of scientificity : “I suggest an experiment…I stayed with Ruth’s ongoing experience…In my version of Gestalt work with Ruth, I watch for cues from Ruth about what she is experiencing in the here and now…My approach is basically noninterpretive. I will ask Ruth to provide her own interpretations of her experience, etc” (Corey, 2001, pp.116-1117). In addition, this book chapter proceeds to theoretical applications on a single practical case, that of Ruth, which raises the question of the diversification of clinical possibilities. Indeed, the fact of presenting only one practical case will reduce the clinical possibilities because the experiences that a therapist can give to his client depend on his singularity by being carried out from his discourse as well as his own history. Therefore, Ruth’s experiences cannot be applied in a “protocol fashion” to other clients because in Gestalt therapy it is important to take into account the uniqueness of the client and the context : “From the cues I pick up from Ruth, I suggest experiments that enable her to heighten whatever she is experiencing” (Corey, 2001, p.118). Thus, due to the lack of scientific evidence in this book chapter and the fact that it is based on a single case study, one must be careful about generalizations.
- COMPARISON WITH SIMILAR STUDIES
This book chapter describes ably Gestalt therapy in a thorough and large way. Indeed, the author, who is a gestalt therapist himself, specified this approach by replacing it in a context even if he could be more specific. Gestalt therapy being phenomenological and experiential, the author portrays this clinical approach in this way. As a matter of fact, by the qualitative paradigm used, he exemplifies the process and goals of gestalt therapy, thanks to a clinical example named Ruth. Theoretical foundation and concepts are explained, although Gestalt therapy’s founders are lacking. Richness of this book chapter is to have access to the dialogue between the therapist and his client. Moreover, this qualitative data is carefully criticized by giving some reading keys in favor to the reader, to allow him to understand the clinical situation which then may be reused in one future practice. Thus, practice reflects theory and conversely concepts and premises clarify how acting and being in the therapeutic relationship. However, some Gestalt therapy’s concepts we read before were missing to me such as the “field” and the name of the “unfinished loop”. Furthermore, this text was aimed at professionals or students in psychology, that’s why it is not very accessible. Nonetheless, we found this book’s chapter relevant because of the description of Ruth therapy and its evolution. In this way, Jon Frew expounds the therapy’s effect to his client too even though we don’t have access to Ruth’s feedback directly. Finally, the author lets her reflection continue thanks to some questions at the end of the text. Those probe to what we are and wish to be as a clinician psychologist from what Gestalt Therapy teached us.
- WRITING STYLE
The purpose of this chapter is to explain and flesh out the theory of gestalt therapy. It seems to be addressed to novice people in this kind of psychology concept or readers who want to refine their psychological knowledge. Indeed we can notice first of all that the first paragraph consists in a short but detailed summary of the gestalt therapy theory: “The goal of the Gestalt approach is […] about the changes that have occurred.” (Corey, 2001, p.110). The chosen words belong rather to an understandable and clear register although they are specific. For instance “here-and-now”, “reexperiencing past unfinished situations” (Corey, 2001, p.110).
The rest of the chapter including the clinical illustration continues the pedagogical dynamic. Several round-trips between the practical example by dialogues and the theoretical explanation, session after session, appear throughout the writing. Thus, it is easy to make connections with the context. Moreover, the therapeutic development process is divided in many short paragraphs. We can therefore progressively follow the steps of analysis of the psychologist and understand the way in which Ruth the patient evolves.”Key Issues and Themes” (Frew, 2001, p.112), “Therapeutic Interventions” (Frew, 2001, p.113), “Process Commentary” (Frew, 2001, p.115), “Some Final Thoughts” (Frew, 2001, p.122). In addition the authors use an interesting and concrete gestalt exercise example: the exchange of chairs with Ruth (“how about changing and sitting in the chair […] safe and secure” (Frew, 2001, p.121)). With the way of doing feedback the purpose is clear and stimulating. The last point is about the last section “Questions for Reflection” (Frew, 2001, p.123). This part is more intended for clinicians or psychology field readers to improve the reflections about what is developed in this chapter.
More generally, the author uses the same words many times and develops the concept behind them by repetition and illustration. “Awareness” (Frew, 2001, p.110-123) for example is written a couple of times. In the end the reader tends to become familiar with these notions by their actualising.
- CONCLUSION
This reading report could end with a short statement about how we felt by reading and what we liked or disliked. First, it’s important to us to say that this article was pleasant to read and reconciled ourself with Gestalt Therapy’s texts in general. Personal therapeutic work seems to us to be a key to being a good psychotherapist, which is why we liked some questions at the end of the article that refer back to the readers, such as : “Are you aware of struggling with any of Ruth’s polarities in your life now?”. Furthermore, we found that this end’s questions allow a more involved learning instead of only reading passively. Thus, reading this article encourages us to read more about this subject, even though we were a little bit reluctant before, notably because of the abstract form of this approach. In this way, we could read about some other patients’ cases because we wonder if Gestalt Therapy is adapted to each type of psychopathology. We even wonder how psychopathology is defined regarding this approach. However, we understand very well how to be a humanist clinician with patients and which therapeutics techniques we can apply.
- VOCABULARY
| KEY TERMS |
| Experiencing : Faire l’expérience Here-and-now : Ici et maintenant Phenomenology : Phénoménologie Dialogue : Le dialogue Subjective world : Monde subjectif Functional diagnosis : Diagnostic fonctionnel Non-interpretive : Non interprétatif Nonverbal communication : La communication non verbale |
| WORDS WE HAVE LEARNED |
| Salient : saillant Heighten : augmenter, accroître Unfold : déplier Boundary : frontière/limite By withholding : en refusant I resent you for : je vous en veux pour The need–fulfillment cycle : le cycle besoin-satisfaction To get rid of : se débarrasser deAbly : habilement Premise : principe Probe : sonder, explorer Enhance: améliorer Sharpen : aiguiser Striving toward : s’efforcer de Embedded : intégré Shift : changement Purely as hunches : purement sous forme d’intuition Cognitive framework : cadre cognitif Inward : intérieur |
- BIBLIOGRAPHY
Corey, G. (Éd.). (2001). Case approach to counseling and psychotherapy (5th ed). Brooks/Cole/Thomson Learning.
Corey, G. (2001). Case Approach to Gestalt Therapy. Dans J. Frew (dirs.), Case approach to counseling and psychotherapy (pp. 110-123). Brooks/cole, Cengage Learning. http://students.aiu.edu/submissions/profiles/resources/onlineBook/s5c5Y5_counseling%20psychology.pdf
Nelson-Jones, R. (2000). Six Key Approaches to Counselling and Therapy. SAGE.