Sunday, October 26, 2014

Case #118 - Aaaaaahhhhh. Oooooohhhh

Marlene came forward. This was my first encounter with her.
I said - I am interested to get to know you, and this is a two way process, so I would also like to hear your curiosities about me.
In Gestalt we are oriented towards a horizontal relationship, developing mutuality, and that includes the client knowing about me, as much as I know about them. This has to be done carefully of course, so that I am not inundating them with information about me, nor inappropriately disclosing more than they are comfortable with, nor doing so for my own needs. This is about enhancing contact and creating the grounds for deepening relationship.
So Marlene made some observations about me, and asked some questions (e.g. about the ring on my necklace). I told her some things about myself, and asked about her as well.
This is more naturalistic than the therapist driving forward with personal questions, where only the client is exposed. It also creates a ground for safety.
I told her the ring was connected to my birthplace, England.
Marlene told me she grew up in the mountains until she was 20, in an isolated place, without running water, or any houses nearby. The environment was completely beautiful, and dangerous - snakes and other wild creatures to contend with. She grew up resourceful, competent and capable.
She expressed this with a gesture of her arms, open wide, and a wonderful sound 'aaaahhh'. This was expansiveness embodied.
She then joined the rest of the world, and wanted to learn to fit in. It was hard for her, as the expectations of being a woman were that she was coy, delicate, and femmine in that sense. Her fearlessness didn't really fit into that.
Nevertheless, she wanted to learn to fit in, to be part of society, to discover a different sense of herself as a woman.
In her marriage she found ways to do this. She was very conscious about playing a role, being dutiful (as a choice) towards her in laws, and constraining her expansiveness.
I asked her for what that gesture was. She made a small circle with her hands, moving towards each other, and a sound 'ooohh', with the cadence going down.
I asked how she felt. She said, patient.
This is not strictly a feeling, but indicates a state of being. A chosen state for her.
This was important to acknowledge, because of its importance to her. And at the same time, I was also interested in her as a person inside her dutifulness and patience. But this was not something she was ready to reveal to me.
So I said - 'when I see your gesture of expansiveness, I feel excitement. When I see your gesture of fitting in, I feel sad'.
This is not a commentary on her. Its a genuine statement of me, as a separate being. She may not feel sad, but I do - thats about my values, which may be different to hers. This is also contact.
In Gestalt contact is about meeting, often at difference, as well as the joining of similarity.
I asked Marlene her experience in the present. She said 'clarified'. There was a lightness about her manner.
She experienced being seen, and met in these places. Just as she was. Further exploration and sessions could unpack much of this, both the context, as well as the experience. But for now, this was a powerful meeting.
In Gestalt we are less about trying to do something, trying to get somewhere, and more about being present with what is, with the person as they are. In this place, healing can take place, and new possibilities can open up, of their own accord. This we call the Paradoxical Theory of Change.

Thursday, October 23, 2014

Case #117 - A life map to follow your bliss

Carlita saw herself with two choices, and she was confused.
On the one hand she was considering going into politics.
On the other hand, she wanted to just 'follow her bliss', and see where life took her, without agendas.
We used a field-mapping process, drawing up all the elements of the situation - and beyond - on a board. This is a way of incorporating the complexity of the field into dealing with decisions like this.
So we mapped many different elements - the pressure from her parents and family to make a mark on the world. Messages from her boss to the effect that she should pursue what was going to get her ahead in life, not necessarily what she really wanted to do.
Included on the map were the things she enjoyed doing - going out, having fun, dancing. I asked how old she was - in her late 20's. This helped me place her in the context of developmental stages.
Dragging down on her from the past, was the pain associated with an abortion, at a time she didn't think she was ready for motherhood.
She said she learned from this that she needed to follow what her heart told her, rather than what she thought about major life decisions.  
I sat with her for a little while, with the pain that talking about this brought up for her.
I felt warmly towards her. I saw her as a bright young woman, full of determination and passion, with a lot to contribute, but not quite having found her groove.
She was about the age of my eldest daughter. As an older man, I wanted to be able to give her something. I told her so.
The authorities in her life - father, boss, family, were all pushing her to fit certain agendas.
So I saw the gift I could give was permission to be herself, no matter what direction she took in her life. I formulated a statement to her, contrary to the one from her boss. I said 'I recognise your strengths, your potentials, and I want to see you follow your own deep knowing'.
This touched her profoundly, and gave her a strength (and approval) to find her own best way.
Ironically, by doing this, I was using the therapeutic relationship to empower her, by bringing in some of my 'authority'. Traditionally in Gestalt the emphasis was on self support, and signals of approval would be very much discouraged, as potentially making the client 'dependant' on the therapist. Whilst caution needs to be exercised, in relational psychotherapy, it can be appropriate to 'live out' the relationship, including  some version of the authority role - therapist, or father substitute - in a way which does empower the client.
In this case, by providing messages to Carlita that supported her autonomy, I provided a counteracting force to the authoritative messages which suggested that she should follow other people's agendas.

Monday, October 20, 2014

Case #116 - Bye priest, hello woman

Brad had been a catholic priest for 10 years. He had left the priesthood a year previously, and was not studying for a new profession. He felt good in his choices, but did not feel he could get close to women in an intimate way. He wanted to find a partner, and raise a family. But the leftover from his priest experience was an automatic distancing from closeness with women, or at least from their sexuality.
The message from the church that he had swallowed - 'introjected' - was that women were 'bad', in that way. This was obviously unhelpful for his present life and future plans, but it was not something that was easily changed.
So I asked him about his father, as I wanted to gauge the attitude towards women in his family. In Gestalt we explore both direct experience, and the context (or Field) of that experience.
He said that his father had actually studied for the priesthood for many years, though he had not taken that step in the end, but got married instead.
This provided a resource in his Field, which I draw on. I pointed out that his father had obviously not found women 'bad', but in fact, had embraced the goodness of sexuality with a woman, and hence Brad's birth into the world.
This was a strong reference point, that could clearly be used to help Brad in his own transition. I asked how long it had take his father after leaving his priest studies, to get married.
Brad replied - 2 years.
I asked Brad how long he had been out of the priesthood - he said 1 year.
This gave me an opportunity to cue in the 'future of the field' - a Gestalt process where we bring the future into the present in the form of an experiment.
I said 'well it looks like its going to take you 2 years as well. Only one year to go. So lets have a rehearsal for when that year is up'. This took the pressure off Brad having to make the transition all at once, gave him a time frame (that sounded realistic and appropriate to me), and gave him some hope that things would change over time.
So I suggested that a woman come out of the group and sit in front of him, for this 'rehearsal'.
She just had to sit there, being present.
I got him to hold up one hand pushing her away (the hand he had used when originally talking about the church idea that woman were 'bad'), and then hold the other hand open to her, in an accepting position. He did this silently at first. He felt a little uncomfortable on both fronts. He found it hard to really take her in, and he also found it hard to let down his guard.
So I could see we needed to do some grounding work.
I asked him about the things that a woman might do to him that were 'bad', and cued those in - she might betray him, she might hurt him etc. In this way, I was converting his abstract fears into more grounded ones - she might indeed do those things to him.
So I got him to make those statements direct to her - 'I am afraid that you might hurt me, or betray me'.
The woman was able to acknowledge - 'yes, I might do those things'.
But then she spontaneously added 'it depends on how you treat me'.
This gave him an important, grounded, and potentially empowering clue - it rested on his choices.
He was then able to let his hand down. The issue was now about his own behaviour, which he did have control over. We always look in Gestalt for places where someone can move from trying to control others, or feeling powerless in relation to them, to a position where they feel the power of their own choice.
However, there was still something blocking him taking her in now.
I asked if he had been through a formal ritual of leaving the priesthood. He said the process was not complete, but that he felt that he had left it.
I was not satisfied with this. Formal processes have profound meaning - divorce, and in this case, getting his final paper from the pope. Until that point, he was not formally 'available'. I asked how much longer that may take - he said, about a year.
This was clear then. Until that point, he would not feel completely free.
So I again suggested the notion of a rehearsal ( example of a Gestalt experiment).
I folded up a piece of paper, and as the 'papal representative' I handed it to him, as a preview of the experience of getting his final paper.
I then invited him to notice what he felt sitting opposite the woman.
He reported feeling a kind of warmth.
'Thats it' I said. 'Thats all you need to do, is feel that warmth, and it will develop naturally from there'. The woman also reported feeling more connection with him.
This piece of work involved references to the field in a number of ways, which helped support, highlight, and direct the process. With such a formal thing as a priest role, there are many external and contextual aspects which also need to be taken into account, above and beyond the specific feelings of the person.

Tuesday, October 14, 2014

Case #115 - Redefining oppressive authority

Angelina reported feeling some feelings of sadness, and guilt, about her 'family'. At first this appeared to include her husband, who she was separated from. But then it became more clear this was about her children - young adults, who she had not seen much of in the last three years of separation.
The situation that she described was that she was enjoying her autonomy, and the freedom that came with pursuing her own dreams. She did not want to give any of this up, it meant too much to her.
I pointed out that sadness and guilt arose in the context of relationship. However, Angelina did not want to talk about or address the relationship with her husband, or her children. She just wanted to feel more at peace.
I could feel there was a power struggle between us. I was not willing to help her do this, without any reference to the relationships that were the context. She did not want to look at them. For me to do this would be to use the therapeutic process to help her block out those relationships better - something I was not willing to do - that did not feel ethical for me.
So rather than continue to push, I took a different tack. I asked her about the context of autonomy. She reported a childhood, growing up in the countryside, with many brothers and sisters. It did not sound problematic in anyway, nor was it clear where and how the importance of autonomy and freedom came from.
Then she mentioned that her father was a strong authority, and I understood. She grew up in a strongly patriarchal family. Her mother was subject to it, she and her siblings were subject to it. There was no autonomy, especially as a girl. She did not get to make any of her own choices. She said her father was not a bad man, just in a role as the unquestionable authority.
Not surprisingly, she married a man who had, for 20 years, been the same. Her husband was not a bad man, but he was also 'the authority', ruling the household in the manner of a patriarch.
Now the context became clear. The only way she could conceive of having her own life was to leave the system entirely, her children included. With the role of wife and mother went the subservience that she was no longer willing to live under. She did indeed value her freedom, after 40 years, more than anything else.
She said she wanted to divorce, but her husband was not agreeing - I suggested it was the last bastion of his control over her. There was a power struggle, and neither of them were going to win that one.
It was clear to me that we needed to work, not with the personalities of father or husband, but the patriarchal order itself. This is what had been oppressing her, and it was hard for her to separate it out from the people.
So I asked a half dozen men to come up from the group, and represent, husband, father, grandfather, etc - the line of men going back.
I invited a woman to come up and stand behind Angelina.
I suggested some lines to Angelina, but was very careful to make sure she said them as she wanted.
The statements were first to her husband - 'I acknowledge you are a good man, and I separate myself from the patriarchal order you are a part of'. We spent some time on this acknowledgement. She felt lighter, but still something of a burden.
So we repeated the process with her father: 'I acknowledge that you were a good man and father, and that I am here because of you. And I separate myself form the patriarchal order you are a part of.'
We did the same thing with her ancestors.
By this point she was feeling much relieved. She was able to be in the presence of these men, without reacting to them, and able to be in relationship to them, yet not agree to being oppressed.
This was a synthesis that she had been unable to achieve to date.
It was a significant experience for her, and she felt greatly relieved.
I finished it there. That was enough for one session, and I was confident that things would flow from that in relation to her children.
The work here was with what we call the Field in Gestalt - the larger and complex context within which we have our experiences, etc. By paying attention to the larger picture, we are able to go beyond the immediate feelings and reactions, and achieve integration with much larger family, cultural and historical forces.
The experiment in this case related to the field, and allowed Angelina find a more settled place within herself, without using the blocking creative adjustment that she had previously been employing. This experiment derived from processes used in family constellation work.
I also stepped out of a power struggle with her - me that man, the therapeutic authority; in Gestalt we never push against the resistance, but always find a way to contextualise it.

Sunday, October 5, 2014

Case #114 - Brewing anger, releasing pain

Melanie was keen to work. However, before we jumped into her issue, I firstly shared something about where I was at in relation to her. This can be a component of the relational Gestalt approach - for the therapist to include their own experience and phenomenology, setting the ground in the therapeutic relationship.
I told her I enjoyed her warmth and sunniness, and at the same time; I felt a genuine desire to support her learning and awareness; and, I also experienced her stubbornness with taking in new information, and integrating that. I told her that I could recognise some of my own stubbornness to learning, as reflected in her way of being.
Sharing my own limitations and similarities helps reduce the shame that could be associated with such feedback and evaluations.
We then attended to her issue. She talked about her pain regarding a boss. She often thought about the situation, one of tension, stress and unhappiness for her, a situation that she felt a lot of pain about.
She outlined some of the details of the situation, as well as some of the previous context.
Then it became clear to me - that is, I got a clear figure myself. In Gestalt, we say that the figure is co-created. It emerges out of both client and therapist ground.
Underneath anger there is generally some kind of pain. Its often useful in psychotherapy to find the underlying pain, and this is the approach used in more subtle approaches such as Family Constellations. It can allow for a less attacking communication.
However, in Melanie's case, she never moved to anger. She always stayed at the pain stage. Anger is useful as it moves the pain forward, outward, and is a spontaneous way to mobilise appropriate action.
So in her case, she needed help in moving her pain into anger. Because she had not being doing that, the pain simply 'sat' there, with no change or resolution.
So I invited her to 'put the boss on the pillow' and speak to her directly. I encouraged her in this experiment to transform her pain into direct anger.
She was able to do this, though she found it difficult.
She felt better, but said 'I usually avoid conflict of this type'.
This was also a key, so I asked a field question - 'what has organised you to be conflict avoidant?'.
She explained about a previous work situation, where she had not been treated well; she had held back and contained herself in that situation, but then had finally exploded. She was warned off any such expressions in the future by her boss at the time.
So it became clear that she was working in a conflict avoidant environment. This gave a context - important in paying attention to the field.
I further explored her historical field; I asked about family context, and she described how as a child she had been the teacher's pet, and so had got a hard time from the other kids. So she learned to try to avoid such conflicts.
I acknowledged the impact of these contexts, and then brought her back to the present, and the possibility of expressing her anger. She said -' but if do, I will get into conflict, and then I will feel pain'.
This represented her 'creative adjustment', her way of processing experience. It can be hard for people to do something different, as the habitual way of responding can be deeply ingrained.
So I tried to give her support on two levels.
Firstly I challenged her belief - this was a cognitive intervention. I suggested that it was in fact the opposite way around - if she was willing to express her anger, she would not be holding onto the pain anymore.
Secondly, I provided the practical support of an experiment which involved helping her explore a skilful way of dealing with the expression of anger in the workplace.
Then came the phrase which I had come to recognise as her stubbornness - 'yes but'.
Fritz Perls would say - anything before the 'but' is a lie. In other words, the so-called 'yes' actually meant 'no' when followed by the 'but'.
Because I had a history of experience with Melanie, and had in fact brought up this very issue right at the start, I knew to decline to 'help' her further.
I said - 'ok, here it is, your pushing me away'.  She said - 'no you are the one who is not going to help me, its you pushing me away'. I said, 'you are pushing away my help - I will leave the work with you'.
Here we see a confusion at the 'contact boundary' - she is not in touch with her pushing away behaviour, so she thinks (quite often) that others are rejecting her, without recognising how she sets this up.
So I stopped. She was not happy at all, but I was not willing to get into a power struggle about her wanting help, but then refusing it when its offered. In the olden days in Gestalt this was called 'bear trapping'. Although this term is rarely used now, and could be used to disparage a client, it does describe a certain phenomena. The trick is to see the behaviour, refuse to pander to it, yet remain supportive and available for real connection.
Melanie brewed on this. Sometime later she started getting really angry. This was a positive step from my point of view.
She said 'I want to pinch you'. I let her show me how- she pinched my arms. I said 'I can feel how angry you are, and I can see in your face how angry you are'.
She wanted to keep pinching me. I said - I really get that you want to hurt me right now.
This was her sadistic side, the product of a lot of stored pain. Now there was a safe place for it to come out, there was a lot of history and a lot of force in it.
However, this is obviously not going to work in relationship. So I invited her to a therapeutic wrestle - meeting hands, pushing against each other.
I could then feel the fury in her arms. We did this for a while. She wanted more.
It was time to finish though. And so I stopped.
Again she was frustrated. What emerged underneath her smiling face, her friendly manner, and her containing the pain within herself... was a fury, and the way she manifested that was though control.
Declining to be controlled is a tricky thing in psychotherapy;  although it is necessary,  it can be easily used to blame or pathologies a client, which is not of benefit.
This is an example where 'frustrating' the client is a healthy intervention - not from an idea that its good to confront the client, but from the necessity in the moment of managing  the 'contact boundary'.  

© Lifeworks 2012


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