A review by Mathilde Glotin-Libeau (892443X) and Alice Vivier (996259Q)
Introduction
“The goal of the Gestalt approach is the enhance awareness of here-and now experiencing.” Leech, N. (2003, p110). The “Case Approach to Gestalt Therapy” gives an insight into the aims, forms, procedures, and goals of Gestalt therapy through the notes and process commentaries that accompany the transcripts of therapeutic interventions of two Gestalt therapists, Jon Frew and Jerry Corey, and the client Ruth.
Summary
Jon Frew states that Gestalt therapy is practiced with a theoretical foundation grounded in field theory, phenomenology, and dialogue. He notes that from Ruth’s autobiography key issues emerge about how she makes contact with her environment. Ruth doesn’t pay attention to what she wants from others, she fears change in general, and attending to her own needs and desires in particular. She engages in contact through “confluence” or blending with others. She fears any expression of her needs and wants could drive her husband away.
He stresses that these are assumptions as all themes must arise in the session and in the dialogue between Ruth and the therapist.
The first therapeutic intervention begins with the therapist asking Ruth to check in with herself by asking “What are you aware of, Ruth, as we begin today?” This brings Ruth into the present moment and heightens her awareness that she rarely attends to her immediate experience. She describes her exhaustion and frustration of living for others. When the therapist asks her what she is experiencing as she describes her nervousness, fluttering stomach, excitement, and apprehension. The therapist suggests an experiment alternating eye contact back and forth with him. She feels frustrated and angry at him. By using this need-fulfillment cycle model to assess how Ruth functions, she will become aware that there are ways of moving into contact with aspects of her environment, being able to assess the present situation and be more aware of her own needs as well as others more accurately. The therapist’s role here is emphatic and non-judgmental. He is focusing on Ruth’s body language in the present moment, creating a dialogue and guiding the session on what he hears and sees. Ruth’s uncomfortable feelings are tied to an assumption that he wants something from her. Supporting Ruth by not challenging her perception of him wanting something from her, led her to another awareness that she was angry at him for not being clear about what he wanted. At this point her anger was directed outward rather than her usual pattern of inward self-criticism. By encouraging her present awareness, her tendency to operate on automatic pilot will be countered so she can more accurately assess the present situation. Eventually, Ruth will be aware of her own needs as well as others.
In the process commentary, Jon Frew talks about the phrase experienced basketball players use about “letting the game come to them” rather than “forcing the action” or “trying to make something happen” which is very similar he says to practicing Gestalt therapy in a dialogic, phenomenological way.
In Jerry Corey’s Gestalt work with Ruth, he watches for cues from Ruth about what she is experiencing in the here-and-now. He suggests experiments (for example giving expression to unexpressed body movements or gestures, talking in a different tone of voice, rehearsing thoughts out loud) by attending to what she is expressing both verbally and non-verbally. In his assessment of Ruth, he notes that Ruth has never learned to have and to express feelings. He writes that she feels guilt but rarely expresses the resentment she is likely to feel, regarding her husband and children or her father who is no longer alive. She has made a lifetime career of giving and doing for her family. She does not express how this arrangement affects her and locks her threatening feelings, sensations, and thoughts inside.
The aim of therapy is for her to express her moment-by-moment experience to free up her energy for creative pursuits instead of growth-inhibiting defenses.
In Jerry Corey’s therapeutic procedures his interventions focus on intensifying here-and-now experiencing, for example when he asks “Ruth, as we sit here, what are you aware of?” or a little later “Let me suggest that you sit for a few moments and listen to yourself”.
Ruth says how guilty she feels especially with her daughter Jennifer. After listing, out loud and unrehearsed, the reasons for her guilty feelings, Ruth then feels relief followed by resentment at Jennifer for expecting her to be a perfect mother. Jerry Corey follows this statement with an experiment where he suggests Ruth replace “I feel guilty for…” by “I resent you for….” His aim here was to direct her anger to the sources rather than inward and trying out new behaviour. Gradually Ruth experiences more freedom in accepting the different parts of herself without needing to cut out certain parts. During the role-play which follows where the therapist sits in as Jennifer, Ruth becomes highly emotional, and this allows her to explore the polarities within herself. The empty chair technique which follows between two sides of herself the “good girl” and the uninhibited one, as well as the role play where she plays her father talking to her as a child, shows Ruth the difference between thinking about conflicts and letting herself experience them.
During the session Jerry Corey notes that Ruth did not need his interpretations. Ruth awareness was, by itself, a powerful catalyst for her change.In Jerry Corey’s work with Ruth reexperiencing past events to deal with unfinished business provides Ruth with valuable insights.
Critical evaluation
The transcripts and process commentaries show that as trained therapists in Gestalt therapy, Jon Frew and Jerry Corey hold space for Ruth. They do not impose their judgement and accept the truth of her experience. This rapport between the client and therapist in Gestalt therapy, the I/thou relationship, is critical in building trust and safety. However, for some clients the lack of formal structure may be a struggle. For Gestalt therapy to be effective, the therapist must have a high degree of personal development and knowledge. Focusing on the present is another hallmark of Gestalt therapy and we see in both Jon Frew and Jerry Coreys’ transcripts how they keep Ruth in the here-and-now, encouraging her to increase awareness of her feelings, her emotions, her perceptions, and her responses. However, as therapists are also human, it’s important for them to consider the influence of their own experiences of what is happening in the session.
The focus on the present and the here-and-now experiences can be seen as a weakness of Gestalt therapy, on the other hand one could argue that it works with the past by making it relevant to the present, as illustrated in the dialogue Ruth has with her father. At certain points in the transcript, we sense that Ruth is uncomfortable with the therapist’s observations of her body language and emotions.
Keeping eye contact is difficult for her but she overcomes this as the session advances. Ruth is willing to try out techniques that could feel unnatural, like the empty chair exercise where Jerry Corey suggests she have a dialogue between her “proper side” and the “uninhibited, daring side”. This works for Ruth as a technique of exploring her polarities, but other clients could find this challenging. The case approach to Gestalt therapy demonstrates how versatile and flexible the Gestalt approach is, however, once more the success of the approach depends on the degree of personal development and knowledge the therapist has. There is a potential danger for therapists to abuse the power they have with clients.
Conclusion
Gestalt therapy focuses on the integration between the “whole” person and his or her environment. This therapy sees a healthy individual as being someone who has awareness in his or her life and lives in the here and now rather than focusing on the past or future. The case approach highlights a part of the journey Ruth is taking towards healing by understanding her perception, giving attention to how she places meaning and makes sense of her world by engaging in intellectual and physical experiences (role-play, re-enactment, etc.) and gives concrete examples of the different techniques used in Gestalt therapy. The techniques used help her to become more aware of thoughts and action, the negative thought patterns and behaviours that block her self-awareness and how they can change. The rapport between the therapist and Ruth is critical. Both Jon Frew and Jerry Corey pay great attention to what Ruth is communicating nonverbally. Neither of the therapist offer their interpretations but guide her so she can discover for herself how some of her past experiences are related to her present feelings of being stuck. As readers we sense how uncomfortable or unnatural some of the techniques feel to Ruth, but she overcomes them. Ruth’s growing awareness is a catalyst for her to take responsibility rather than placing blame. Our overall feeling is that the Gestalt therapy approach is versatile and flexible and will help Ruth to take the next steps in her own personal growth and development.
Gestalt Therapy: Key terms
Awareness: conscience
Wholeness: intégrité
Here and now: ici et maintenant, le moment présent
Growth disorder: trouble de la croissance
Experiential therapy: thérapie expérientielle
Words We Have learned
Phenomenology: phénoménologie .Is the study of « phenomena »: appearances of things, or things as they appear in our experience, or the way we experience things, therefore the meanings things gave in our experience.
Dialogical approach approche dialogique A dialogical approach focuses on building understanding and deepening insight through questioning and dialogue.
Figural: figuratif relating to or denoting a form of signification which relies on imagery and association rather than on rational and linguistic concepts.
Salient: saillant adjective/ˈseɪlɪənt/ most noticeable or important. Example: “It succinctly covered all the salient points of the cas
Need-fulfillment: besoin d’être satisfait
Case Approach to Counseling and Psychotherapy (5th edition). Social Work Education, 22(2), 231-233.