Towards an evidence base for gestalt therapy: the gestalt CORE project

The latest issue of The British Gestalt Journal features an article writing up the findings of the gestalt CORE project (hereafter Stevens et al). In their own words:

This is the account of a three-year research project within the Gestalt therapy community in the UK. It is an example of clinically-based, mostly quantitative research carried out in a methodical and rigorous way, using voluntary effort and minimum funding. The results can be compared with national databases of similar UK studies and show that Gestalt psychotherapists are as effective as therapists trained in other modalities working in the NHS and in primary care (p22).

The issue of evidence-based therapy is a thorny one in the UK, and one which places Stevens et al’s research into an interesting political category. I have a mixed reaction to these research findings, so offer that reaction here. I’ll conclude with congratulations to the people who put this research together because (and I apologise for this in advance) it was clearly a hardCORE effort.

NICE

Let’s start with NICE guidance, because it’s not always all that nice. NICE (or The National Institute for Health and Clinical Excellence to its friends) is a laudable organisation with laudable aims.

From its what we do page: “we develop evidence-based guidelines on the most effective ways to diagnose, treat and prevent disease and ill health”.

From its who we are page: “the National Institute for Health and Clinical Excellence (NICE) was set up in 1999 to reduce variation in the availability and quality of NHS treatments and care – the so called ‘postcode lottery’”.

So, NICE exists in order to ensure that someone in BS6 gets the same quality of treatment as someone in S13. This is basically a Good Thing; no one really wants to die or experience extended pain and suffering because their doctor didn’t get the memo. Which of course leads us to how we decide what is effective in any given case, which in turn leads us to evidence-based care. If I’m going to be prescribed medication, I want it to be the most demonstrably effective medication for my condition, not the only one my doctor knows about (or worse, the one whose company was more effective at marketing to my doctor).

This is all classic medical model stuff. The human body is this really cool machine, and when it breaks or malfunctions, you just identify the faulty part(s) and fix it/them. Since the introduction of that model, infant mortality rates have dropped, diseases that used to be deadly are now fairly routine, and heart transplants are possible. I don’t think anyone really wants to throw out this particular baby.

The bath water, however, is another story. While the medical model allows for miracles when applied to physical conditions, it frequently stalls when applied to issues generally related to the experience of being human. The very idea of mental illness is itself a logical fallacy that presupposes a genuine separation between mind and body. And that leads us into problems because, having presupposed the existence of a distinct ‘part’ called the mind, the medical model then attempts to identify the part of the mind that is malfunctioning in order to fix it. Hence the rise of psychopharmacology and the fallacy of the chemical imbalance model of mental illness.

The conclusion of all this is that, when presented with people whose suffering has more to do with the experience of being human rather than their human machinery, NICE continues to assume it is essentially dealing with a machine and seeks standardisation. And that standardisation requires an evidence-base that strips away the humanity of the individual in order to discover the essential underlying problem. Which simply isn’t possible when there is no essential underlying problem; the so-called malfunction is itself an expression of the humanity of the individual.

And this leaves a major problem for gestalt, because the NHS is the main provider of ‘mental health’ services, and its IAPT (improving access to psychological therapies) programme follows NICE guidance. And NICE guidance strongly favours CBT for treating mental health problems because, as Stevens et al acknowledge, it has a bigger evidence base:

CBT has had the most exposure to clinical trials since it uses set protocols which enable standardised collection of quantifiable data (p22).

Given why NICE has been established, this is understandable. From the perspective of the medical model, clinical trials establish efficacy of method, and set protocols allow for standardisation. Try establishing a protocol for ‘sitting with the uncertainty’ or ‘intuiting my client’s desensitisation on the basis of changes in my own bodily experience’. Quite.

So that’s my meander into NICE and evidence-based therapy. What I’m establishing here is the political ground against which Stevens et al’s research needs to be taken: the therapeutic hegemony of CBT.

Research findings, self-validation, and the equivalence paradox

The key finding of this research is that gestalt psychotherapists are shown to be as effective as other types of psychotherapist according to CORE data. Stevens et al used three other studies with which to compare results. I’m not entirely clear why these three particular studies were used or which other studies were passed over for inclusion, so I think the article would have benefited from a literature review. The result of the comparison is that two studies with large datasets provide benchmarking material, whilst the third study focused on minimally trained mental health counsellors.

My response to these results has been interesting. I was angry at first, in the ‘well tell me something I don’t know and this is just political maneuvering not real research’ vein that is the clearest sign one of my buttons has been pressed; the animal anger of being prodded somewhere sore. A bit of licking later and I realise I am relieved. As a therapist, I sit with a great deal of doubt. I doubt that I’m effective. I doubt that gestalt is effective. I doubt that psychotherapy is effective. After all, if it’s all essentially placebo, then I’ve spent a lot of money, time and energy training in the interpersonal equivalent of prescribing sugar pills. My anger was masking a more fundamental feeling of ‘thank fuck for that!’. There is something vindicating about seeing quantitative research with headline numbers that appear to prove what I do is effective.

Now, pursuing that need for external validation appears highly antithetical to the gestalt therapy that Perls et al originally set down, and I think that will make this research controversial within the gestalt community. On the one hand, I practice a therapy that emphasises organismic self-regulation and the importance of self-validation over living up to externally imposed standards. On the other hand, the rise of CBT as the NICE approved therapy of choice is a genuine social challenge that I want to make contact with, not avoid. As Stevens et al point out:

If as Gestalt therapists we do not take seriously the challenge to articulate and evaluate our therapeutic claims we may be left talking only amongst ourselves and limited to working only with those clients who can afford to pay privately (p26).

I have introjected gestalt therapy if I use the ‘but Perls said I should discern things for myself and not be concerned with empirical validation’ line of defence to block contact with a genuine social challenge. If need organises the organism/environment field, then the fact that standardisation and evidence-based practice is organising the field of psychotherapy provision demonstrates the operation of powerful needs. Furthermore, if many gestalt therapists are, like me, not trained in quantitative research methods and don’t have backgrounds in academic psychology, then we are in danger of not contacting the woods for our own projected trees.

All of which serves to focus me on the CORE methodology and what Stevens et al identify as the equivalence paradox: “treatments that have different and incompatible theoretical backgrounds, philosophies and techniques tend to have the same degree of success as measured by CORE” (p24). In addition, the study focusing on minimally trained practitioners showed what I would have hypothesised; that minimally trained practitioners were less effective than professional practitioners.

This equivalence paradox speaks to an intuition in me that for all our different approaches to doing therapy, as practitioners we are all essentially undertaking the same journey only with different preferred routes and ways of travel. Psychotherapy theory seems to have more to do with the preferences of the therapist than it does the effectiveness of the therapy itself. Which is incredibly ironic because it means that, in the arena of working with the human experience, diversity of method actually leads to standardisation of efficacy!

On the other hand, maybe the equivalence paradox is actually an inherent flaw in CORE methodology itself. Perhaps the statistics are simply recording client expectation of what should be the case rather than effectively measuring what actually is the case. A key question there would be whether the clients in the minimally trained practitioner study knew that their therapists were minimally trained and adapted their expectations accordingly.

Politics and dialogue

Where I seem to end up with all this is a sense that Stevens et al have provided gestalt practitioners in the UK with a valuable opportunity to take part in a national conversation. That makes this research political as it has more to do with positioning gestalt in the professional field than it does developing gestalt practice. Both are valid reasons for research.

Ultimately, politics is an opportunity for dialogue about how key collective issues are to be addressed. And dialogue, as I am keenly aware as a gestalt practitioner, necessitates a willingness to open to contact with an other in such a way that risks being forever changed by the process.

And by definition that works both ways. Stevens et al used the CORE methodology not because it is finely attuned to the needs of gestalt practitioners; the writers acknowledge that there is no gestalt therapy box on the forms that need to be filled in (p23) and that filling out forms every session is quite alien to gestalt’s relational approach (p26).

Rather, the CORE methodology was used because it is a well-established outcome measure that allows for comparison with many other studies, including CBT (p22). In therapeutic terms, Stevens et al decided to learn and use the language of the people they are trying to reach rather than impose their own. Once gestalt therapy as a profession is part of that ongoing conversation, we can then also deconstruct introjections about what should count as an evidence-base and better dispel projections about gestalt therapy as an approach.

Finally, what this also highlights for me is the politics of research as an activity in itself. Having conducted my own, qualitative research, I’ve needed to address the issue of researcher bias and the various political and philosophical assumptions that underlie research as an activity. Basically, who asks what questions and why?

With respect to the gestalt CORE project, the GPTI (Gestalt Psychotherapy and Training Institute) discussion list was the birth place of the CORE project, growing out of “gestalt therapists’ concern to find a way to research the effectiveness of their work” (p22). GPTI also funded costs associated with CORE software and training for the first year to get the project started. Gestalt therapists volunteered to take part in data collection, and The British Gestalt Journal hosted a recruitment page with information about the project and downloadable forms.

One way of looking at this research, then, is this: a group of gestalt therapists, with funding from a gestalt therapy organisation and assistance from a gestalt therapy journal, have conducted research whose findings claim gestalt therapy is as effective as other therapies. This appears to justify one of Babette Rothschild’s favourite phrases: outcome focused research is some of the most biased research there is.

I think this bias is real and would hopefully be recognised by Stevens et al. However, I don’t think that recognition of vested interests damages the research. Rather, I think it opens up nicely the same question of vested interests for outcome focused research in general, and CORE studies in particular. After all, “the CORE measurement is primarily designed to provide managers and practitioners with evidence of service quality and effectiveness” (p23). The whole point is to demonstrate the level of effectiveness, not falsify.

Consequently, the inevitable criticism that can be levied at Stevens et al (ie your research is biased by the vested interests of those concerned) applies equally to other studies and only serves to demonstrate the impossibility of the neutral researcher; the motivation to research has to come from somewhere.

Congratulatory note

What I hope this post portrays is my attempt to reconcile my own thoughts and feelings about the possibility of evidence-based therapeutic practice with my recognition that this is an important piece of research for gestalt therapy.

My congratulations go out to Christine Stevens, Jane Stringfellow, Katy Wakelin, and Judith Waring for putting together this research. This was research conducted by volunteers, outside of academia, and with minimal funding. That is in contrast to CBT as an approach, which has an easier time gathering an evidence-base precisely because there is a greater abundance of resource aimed at producing that evidence-base.

In conclusion, I think those involved can consider this to be three years well spent, and I’ve enjoyed the challenge of chewing over this research.

Article reference:

Stevens et al (2011) The UK Gestalt psychotherapy CORE research project: the findings; The British Gestalt Journal, Vol. 20 (2), pp22-27 (online ref)

My reflection on The People’s Bristol 2050

I look around the room at the couple of dozen people making a rough circle; some sitting, some getting coffee or tea, a couple of groups chatting. It’s coming up for the scheduled 2pm start, so I decide I’ll use the toilet then come back and call everyone together to get started. Off I go.

Returning about five minutes later, the circle has expanded and a steady flow of people is coming into the room. Before I know it, a couple of dozen people has become more like sixty or seventy, and I’m wondering what the hell I’ve got myself into. As it happens, I don’t have enough time to give that question full consideration; there’s an Open Space meeting to start…

That’s pretty much how the first event of The People’s Bristol 2050 got going. This is a response to another Bristol 2050, a business vision of what Bristol should look like in 2050. Co-ordinated by Business West, it “provides a clear statement about jobs, housing and infrastructure requirements to meet the needs of the area and to continue to develop and grow as the economic powerhouse of the South West”. As usual, these are the needs of the area according to business leaders; after all, business leaders have been doing so well in addressing society’s needs lately.

Whether historical coincidence or zeitgeist we may never know, but at about this time, Occupy Bristol had developed into two branches; one that wanted to move on from College Green, and one that wanted to resist eviction. The question of what happens to Occupy Bristol as a movement is one that will be addressed in a public meeting on Saturday 4th February, 2pm to 4pm, location to be announced (the facebook page for this is here).

Among the people who wanted to move on, the idea of developing a People’s Bristol 2050 to rival the business vision offered a new direction in which to aim some of the raw energy of Occupy. What these events demonstrate is that the Occupy Movement as a whole is a crucible from which many different things have the potential to emerge; it all depends on who directs their energy into the mix.

In more gestalt terms, the open space event on Saturday created a fertile ground with the potential to mobilise a wide variety of social actions. There is a buzz that I’ve noticed in every open space event I’ve been involved with, and I can only describe it as being plugged into a circuit of human power, rich with potential.

The downside to many open space events is that, as stand alone events, that buzz inevitably fades, leaving people with a sense of potential unachieved. This makes the People’s Bristol 2050 extra fascinating to me because the next event is already being planned for roughly four weeks time, with the intention being for a series of these meetings to take that buzz and develop it.

Except that there is no one centrally to develop it into anything; the idea is to support a process that challenges the people who turn up to take action for themselves. The idea is to move from a sense of “someone should really…”, to “I am going to…”. Instead of handing over power to someone else, the spirit of open space is to take a group of people and give them the minimum structure necessary to support self-regulation.

And to me, that sounds like gestalt therapy in action as a progressive social force.

Occupy Bristol II: A call for volunteers

I’m going to be facilitating a planning event for a group of people intending to run discussion events for something called Bristol 2050. This is a development of the Occupy Bristol movement by people who are interested in ‘what happens next’, ie how best can Occupy Bristol evolve. The aim is to use the Open Spaces methodology to explore the kind of society people want to live in by 2050.

The planning event will itself be an Open Spaces event as that is the only meaningful way to learn an approach to group discussion that I will wax lyrical about another time. For now, what is needed are people who are interested in getting involved at this stage. The focus of the planning event is making Bristol 2050 as open to as wide a range of voices as possible, and how to make sure events run smoothly. An interest in evolving participatory democracy in a manner that is accessible for a wide range of people is pretty much the only pre-requisite; Open Spaces is very easy to get to grips with and is designed to be empowering.

If you’re free Saturday 21st January, then the training event will take place in the upstairs hall at The Trinity Centre in Lawrence Hill, 2pm to 4pm. Apparently there will be an indoor picnic in the downstairs hall all day and we’ll be welcome to drop into that.

Email me (simon@silvercatpsychotherapy.co.uk) if you’re interested. If you’re interested in getting involved and can’t make the 21st, then still email me, your support is bound to be helpful at some point!

I’ll elaborate on this in another post, as I see a large overlap between this process and the spirit of gestalt therapy. For the time being though, this is the call to arms, and I’d appreciate it if you could spread word to any Bristol-based people who might be interested.

One year of le chat d’argent!

Happy birthday to you
Happy birthday to you
Happy birthday le chat d’argent
Happy birthday to you!

Today marks one year of blogging as le chat d’argent. There’s probably a neat autobiographical case study here on the undoing of retroflection, so maybe I’ll write that up some time. That seems a bit serious for a birthday celebration though; besides which, I’ve not written in any focused way on modifications to contact yet so it would also be jumping the gun.

So how to best mark one year of blogging? As I ask that question, I start to imagine a retrospective from three perspectives: my favourite posts, my most read posts, and my most discovered posts.

I seem to be developing a theme of threes lately, so will continue with that trend.

And if any of you regular readers want to join in with your favourite le chat post from 2011, then please comment; I’ll welcome the feedback.

My three favourite posts from 2011

Really, this would be better titled “the three posts from 2011 that I currently favour” as I imagine I’d list a different three this time next month. I don’t think I’ll put these in an order of bestness and instead take the three that most stand out for me.

In which case:

1) The psychopathology of boredom for the irony win of writing a convincing piece of therapeutic blogging on boredom as a result of being bored.

A) Zen and the art of improvisational therapy for contributing to my ongoing efforts to assimilate and blend my current level of understanding of zen and gestalt.

i) How to spot an end of level boss: a four point guide for seamlessly uniting Final Fantasy VII and Joseph Campbell’s Hero with a Thousand Faces into a list based post that is changing people’s lives even now (probably).

I also like these three posts for having titles with good form.

My three most viewed posts from 2011

The wordpress dashboard provides a statistics section that allows me to indulge my secret love of numbers.

Unfortunately, wordpress blogs seem to attract a certain amount of bot traffic whose purpose seems to be to trick bloggers into clicking through to another site. Presumably this is related to website traffic generating income or providing an in for malware.

In any case, it means it’s hard to be sure how many of these visits are actual people, and how many are the digital footprints of some bizarre swarm of coded bots. The internet makes for a surreal ecosystem.

In ascending order then…

3) Weeping for Narcissus: a review of Black Swan with 205 views.

2) Gestalt essentials: the meaning of ‘gestalt’ with 212 views.

1) Frozen face syndrome with 224 views.

My three most discovered posts from 2011

The wordpress dashboard also lets me see which search terms have resulted in a click through to which particular post.

For my private practice website, this sort of thing is important because what I really need is to be on the first page of google searches for phrases like “therapy bristol“. One SEO tactic is to ensure that links to my site use the keywords with which I want to be found (hence my case in point in that last sentence). Apparently anyway, Google’s search algorithm is a secret so no one really knows.

For my blog this is more about interest and attracting new readers. So, writing my review of Black Swan meant I ended up with lots of therapy-oriented Black Swan searches (mostly some combination of “Black Swan narcissism”). Presumably that means writing about current hot topics from a niche perspective is a way of attracting bursts of new visitors.

More interestingly, that suggests much in the way of figure/ground composition and need constellating the organism/environment field with respect to internet search engines (I know, I’ll put it on my future posts list!).

In the meantime, it turns out that I can’t actually find out what I thought I could find out, so I’m going to hastily adapt. Here is a list of some of the more interesting search terms that have brought people to my blog:

“in gestalt psychotherapy what does it mean if x, y, and z happen”; brilliant, I commend anyone who puts things in terms of x, y and z.

“cbt can be used as a toolkit whereas gestalt is more holistic”; I’d say this is more a question of therapist style, but yes, this is certainly the stereotype.

“advantages of the monster technique – gestalt therapy”; MONSTER TECHNIQUE! One Google search later, and here is the monster technique for the curious.

“do you have a problem in your life flowchart”; one of those awkward questions.

“is black swan suitable for children”; as a public service I would like to categorically state that no, it’s really not.

“essentially, the gestalt approach to dreams is to become and experience as much of the dream content as possible. this is in contrast to an analytic approach in which the dream’s meaning is interpreted; either as your way of symbolically coding what you know to be true but want to avoid knowing (freudian tradition), or as your way of manifesting collective archetypal forces (jungian tradition)”; so it turns out that Counselling Directory google search paragraphs of article submissions because they have a policy of not duplicating online content. Alas, that there paragraph is from Dream a little dream of me, my blog post about the gestalt approach to dreams. I thought it would make a good article but got a Dear Le Chat rebuff email. Woe.

“according to gestalt theory, the menu of a diner for a hungry woman would be”; a clear figure against the ground of her hunger. Or a confusing mass of words if she’s ego-bound and unable to form clear choices.

And finally, the somewhat extreme question, “are you going to slay the dragon or is society going to eat you up monomyth”. Well, are you?

Welcome to 2012

And so that’s one year of blogging done, and the second year lays ahead like some sprawling landscape. The Queen’s Jubilee, the Olympics, the end of the Mayan long count. All these things lay in the year ahead.

In the meantime, let us eat (birthday) cake.

New Year’s Resolutions: how to set process goals

Having previously lamented a dislike of list-based posts in my character assassination of Father Christmas, a so-called Facebook friend pointed out that I’d previously blogged a four point guide to defeating end of level bosses. Ok, so she didn’t directly call me a hypocrite but I think we all know the word was hanging in the air (and the first person to accuse me of projecting will get a prompt ‘I know you are but what am I?’)!

Clearly then, I’m about to present a list-based post. And, as this is early January, the handy topic of New Year’s Resolutions is flowing fairly consistently down my twitter feed. So, a gestalt take on New Year’s Resolutions it is.

Process goals

In simplest terms, a process goal is a direction rather than a destination. A process goal is ‘I’m going to improve my fitness’, whereas an outcome goal is, ‘I’m going to run the London Marathon’. And so on. This is highly relevant to gestalt because, as the mighty Yontef has pointed out in his equally mighty Awareness, Dialogue & Process, the goals of gestalt therapy are process goals.

More specifically, the process goal in gestalt therapy, according to Yontef, is raising awareness. That is very different to the approach of a therapy like CBT where the outcome goal is changing thoughts and behaviour. Gestalt, after all, points to a paradoxical theory of change in which change is the natural by-product of simply being (as opposed to trying to be). Simply being is incredibly difficult given how much effort years of socialisation have put into informing each of us who we should be and what we should do. Simple doesn’t mean easy!

So, taking process goals as a journey, here’s a three stage breakdown that, as an added bonus, lays some groundwork for a later post on the gestalt cycle of figure formation and destruction. I spoil you, really.

1) Starting the journey – motivation

In terms of the gestalt cycle, this is fore-contact, the stage at which support for action is generated. For me, the most important starting question isn’t what am I going to do? Or, what is my end goal? The most important question is why? Why am I doing this? What’s my motivation here?

Take two of the classic New Year’s Resolutions, giving up smoking and losing weight. What is your motivation for doing either? Because you genuinely want to or because you think you should? There is a subtle but powerful difference between those two motivations. Mainly, proceeding from a should-based motivation will likely lead very quickly to the infamous topdog/underdog split.

That is, the part of you laying down the law and demanding that such and such should be done becomes a domineering topdog that gets resisted by another part of yourself that doesn’t want to change; this becomes the underdog. Topdog and underdog then expend much energy wrestling with each other, which is all rather futile considering that both characters are in fact the same person.

As a general rule, if you force yourself to do something you don’t feel a genuine need to do, then you will sabotage yourself at some point. Making motivation incredibly important; find the things that light an internal fire and you’ll find that your ability to wrestle with the difficulties you come up against will be much more doable because you’ll be doing it whole-heartedly.

Ultimately, ‘I want to do x’ trumps ‘I should do x’ because the former is your agenda, whereas the latter is nearly always an externally imposed agenda, however internalised. If that ‘I should give up smoking’ or ‘I should lose weight’ is actually connected to a felt need of ‘I want to be healthier’ then start with that need. There are lots of things you can do to be healthier that don’t involve giving up smoking or dieting, so think of them. Suddenly, you realise, ‘well, I have always wanted to take up tango or karate’; great, so now take up tango or karate! Your health will likely improve because both are great exercise.

There is very little point in resolving to do something unless you have a genuine interest in doing it. Genuine interest proceeds from a personal need, and is motivational.

2) On the journey – experience

In the gestalt cycle, this will be contact, the stage at which action takes place and contact is made with what is being done. This is the realisation that taking a walk is as much about stopping to smell the roses as it is about arriving somewhere, and that makes the quality of the journey important.

This is another reason why doing something because you should do it leads to self-sabotage; the things that we are under obligation to do (unless they coincide with what we also want to do) are unsatisfying. They are unsatisfying because a significant part of us (our dear friend the underdog) doesn’t want to do them. And so we actively resist the very thing we are doing. Picture that supermarket scene where the parent is dragging a screaming child around. Parent = topdog, child = underdog. Is either side of that conflict getting any satisfaction from their shopping trip? Exactly.

The same thing applies for a resolution. What a great start to the year; ‘this year I will expend as much energy resisting something I don’t want to do as I will forcing myself to do what I don’t want to do in the first place’. And so your experience of that journey becomes stressful and unsatisfying.

My point here is that, having proceeded from a good motivation, the experience of the journey needs to be satisfying enough to sustain the effort you’re going to be putting into it. People who get satisfaction out of challenges are all about this part of the journey; the experience of being challenged is rewarding in itself. Most people get satisfaction out of some degree of challenge; for some, that’s diving in at the deep end, for others it’s moving slowly out of the shallow end. And if you find challenge overwhelmingly frustrating, then don’t challenge yourself! After all, lots of people could do with a resolution of ‘I will take it easy on myself this year’.

There is very little point in resolving to do something unless you are going to experience what you’re doing. For one thing, only by being in your experience will you be alert to the relevance of what you’re doing. For another, if you skip the experiencing of what you’re doing, it won’t be very satisfying.

3) Finishing the journey – destination

In the gestalt cycle, this will be the post-contact stage where the satisfaction of completion is experienced and the figure of interest is withdrawn from. This is sitting down after a job well done, sighing, basking a while in the after-glow, and then letting the whole thing go.

Eventually, you will lose interest in whatever you’re doing, either because the need you set out to fulfill has been fulfilled, or because the need is no longer there. This is absolutely the number one reason why I prefer process goal therapy to outcome goal therapy. Frequently, the goals a person has when they come into therapy change over time, or the thing a person wants to change is actually what’s holding them together, or it’s not the real issue but the one they think they’re allowed to get help with. And so on. And this is why gestalt therapy focuses on raising awareness, and lets change happen as a natural by-product rather than aiming for a specific change.

In terms of process goals, the destination isn’t the pre-destination of an outcome goal: eg, I’ll have arrived when I’ve lost however many stone. Rather, arriving is a felt sense of completion: eg, I feel satisfied with how much fitter I feel now and no longer need to push myself. Remember the topdog/underdog conflict. If you get halfway to your pre-destined target and feel that’s good enough BUT continue pushing yourself to achieve that target, you’ll be straight back in that supermarket with the screaming child! It is literally the case that you don’t need to do any more than you need to do. And the sign that you’ve done what you need to do is losing interest.

There is very little point in resolving to do something when you’ve already done as much as you’re interested in doing. If anything, the effort it will then take to soldier on in the name of the final goal will likely ruin much of what was satisfying and turn the whole thing sour.

In conclusion

As the Staff-Tow Uncertainty Principle states, the more we focus on outcome, the less we can focus on process, and vice versa. Setting process goals for New Year’s Resolutions may not allow for smashing ever higher targets, but it will allow for living a more satisfying 2012.

Happy New Year!

Gestalt essentials: contact, the contact boundary, and awareness

I want to get down more of the nuts and bolts of gestalt theory; I would like this theory to be more widely accessible and understood than it is currently. Gestalt therapy is more than Gestalt Therapy Verbatim and That Gloria Video. In some ways, the Perlsian gestalt of Verbatim is more a branch of psychoanalysis than the gestalt of Gestalt Therapy: Excitement and Growth in the Human Personality. The essential difference being that it was Paul Goodman who articulated gestalt theory in Excitement and Growth, and Perls who demonstrated his own theatrical style in Verbatim.

Having already explored the meaning of ‘gestalt’, I think the next essential concepts are ‘contact’, ‘contact boundary’, and ‘awareness’. Given a good grounding in the concept of contact, the concept of the contact boundary that emerges from it, and the concept of awareness that allows us to navigate contact in the moment, it is possible to do a surprisingly huge amount of therapeutic work. Pretty much every clinical presentation can be described in terms of contact and the modification thereof.

As contact is something that each person actively does, it follows that the extent to which I can work with how a person makes, breaks, and modifies contact in a given therapeutic situation determines the extent to which I am able to offer effective therapy. It doesn’t matter how brilliant my interpretation of the root cause of a person’s current problem is if they are unable to make contact with what I’ve said; just like a joke is only funny if someone gets it. I give contact such a heavy focus because the only clinically useful material is that which both me and my client are able to make contact with.

Contact in a nutshell

A simple experiment for you:

1) Press the palms of both your hands together. They are now in contact with each other.

2) Pull your hands away from each other. They are now out of contact with each other.

3) Keep your left hand still and move your right hand until your palms are pressed together. Your right hand has made contact with your left hand.

4) Keep your right hand still and move your left hand away from your right hand. Your left hand has broken contact with your right hand.

That’s the gestalt concept of contact in a nutshell.

Contact with a bit more theoretical elaboration

Contact is the abstract equivalent of the experience of touching. It is impossible for anyone to ever not be in contact with something. I am enveloped by air. I am pulled to the ground by gravity. I am bombarded with light. My body’s central nervous system is in contact with the various parts of my body that it’s supposed to be in contact with. At least, I think so; I’m not that advanced with my anatomy so I don’t necessarily know. But I am in contact with my sense of not knowing at least.

The reason I prefer the term contact to the term touch is that the connotations of touch are more to do with contact with the skin. Contact encompasses this as well as the metaphorical idea of touch; such as being in touch with the zeitgeist, having the magic touch for repairing cars. And so on. Contact is when one thing touches another thing, in a literal physical sense or a metaphorical sense.

I will go into what this means for the gestalt concept of self in another post. For now, the basic sense of contact as the abstract equivalent of the experience of touch, and of contact being something that a person actively does, are most important.

The contact boundary in a nutshell

Continuing on from the experiment above:

1) Press the palms of both your hands together. The expanse where your palms are in contact with each other is the contact boundary.

2) Pull your hands away from each other. Your hands are no longer in contact with each other BUT each hand now has a contact boundary with the air.

The contact boundary with a bit more theoretical elaboration

The contact boundary is the theoretical borderline between one thing and all other things with which that thing is in contact at any given time. It kind of is but kind of isn’t an actual part of one thing or the other. There is no contact boundary without two separate things being in contact with each other.

Of course, we’re not talking about the contact boundary between inanimate objects here but between a person and their environment and/or other people. So, my contact boundary is the borderline between me and all other things with which I am in contact at any given time.

Now, referencing what I’ve said about contact above, the things I can be in contact with at any given time include thoughts, feelings, and abstract ideas. Not only is my contact boundary continuously changing moment to moment, my contact boundary is both physical and metaphysical.

So when I say that someone is invading my sense of personal space, I am referring to a metaphysical aspect of my contact boundary. If I am distracted from conversation with you because ‘my mind is on other things’ (say, a piece of research that is still ongoing) then while my contact boundary encompasses both physical aspects (my perception of you in this moment) and metaphysical aspects (my sense of the ongoing research project), I am adjusting my boundary to modify my contact with you so I can put energy into making contact with my sense of my ongoing research.

I don’t necessarily feel like this is choiceful activity because much of the operation of my contact boundary is automated. However, the automated activity of my contact boundary is a kind of delegated authority that nonetheless is a choice I have made at some point, or the consequence of a choice I have made at some point.

Awareness in a nutshell

One more experiment:

Answer this question as immediately and honestly as you can:

What are you aware of right now?

Awareness with a bit more theoretical elaboration

Just as contact is the abstract equivalent of the experience of touching, awareness is the abstract equivalent of the experience of seeing.

Awareness is the internal light I use to see what I am in contact with. Without awareness, I am fumbling around in the dark, impacting and being impacted without a full sense of what it is I am encountering. I feel sad suddenly with no idea what has made me sad. I feel frightened with no idea what has made me frightened. My thoughts dwell on this or that and I have no idea what this or that is doing in my thoughts.

So I switch the light on and bring these things into awareness. And that’s not easy because awareness is actually an ability that I need to discover and train. Do I spread a dim light widely to catch a broad sense of the landscape, or focus a bright light thinly to pierce into the very nature of something?

In the experiment above, I ask what you are aware of right now. Your response to that question will let you know what is in the light for you. Essentially, there is so much occurring at my contact boundary at any given time that I would go mad if I was aware of all of that activity at once. The next time you see a tree full of leaves, try becoming aware of every single leaf as an individual leaf rather than being aware of ‘a treeful of leaves’. Or indeed, try hearing each and every word spoken in a room full of people speaking at the same time.

Awareness is the experience that I know I am experiencing. Experience in awareness is what gestalt therapists tend to call ‘good contact’. This can lead to some conflation of contact and awareness; for example, someone might be said to be ‘out of contact with her sadness’ when what is meant is ‘her sadness is out of her awareness’.

So, when I see a client’s eyes well with tears, I might say, ‘I notice your eyes look watery to me’. It may or may not be that this water signifies sadness; I can probably guess given the context. But I don’t need to guess; I just share what is in my awareness. Suppose my client then cries; it may be that my observation has brought her sadness into her awareness.

Now we can say that the fact that she was already in contact with that sadness is evident by her tears; what my observation supports is the ‘good contact’ of being in contact with sadness with awareness. I find this an important distinction because the difference between contact and awareness is the difference between the existential fact of my actual situation (my contact boundary) and my subjective experiential knowing of my situation (that part of my contact boundary that is in my awareness).

So, parts of my contact boundary can be in awareness at the same time as other parts of my contact boundary being out of awareness; contact is a pre-requisite for awareness; and ‘good contact’ is contact with awareness.

Four reasons I set man traps for Santa

I have an irrational and visceral dislike for list based blog posts. Every time I see a blog post title that goes “ten reasons why…” or “the seven principles of…” etc, a little piece of me dies and reincarnates as a berserker with a nasty case of blood lust.

Gestalt itself seems particularly fond of the number five for this sort of thing; hence Perls’ five layers of neurosis; Parlett’s five principles of field theory; and Clarkson’s five levels of relationship. I mean seriously, at least try some different numbers people!

Anyway, one of the things that makes me a gestalt therapist is my pre-disposition towards noticing what gets my hackles up, having an internalised therapist/supervisor/trainer jump up and declare ‘projection!’, and then crossing over to my dark side for a bit to see what it’s all about.

So here’s a festively themed list-based post about my irrational and visceral dislike for everyone’s favourite mince pie munching bearded reindeer abuser.

Four reasons I set man traps for Santa:

1) he is a patriarchal symbol of parental tyranny

2) he is a capitalist symbol of social control

3) he is an agent provocateur for the Coca Cola corporation

4) … this one’s a secret, shhhhhh!

Stick with me while I elaborate, it might just change your life…

1) he is a patriarchal symbol of parental tyranny

It’s Father Christmas, not Mother Christmas. Ok, so lip-service gets paid to gender equality by a number of films that do cast a Mother Christmas. But that actually serves to highlight the underlying patriarchal assumptions; Mother Christmas is always cut from the long-suffering-wife-whose-husband-is-a-really-important-public-figure cloth. It is Father Christmas who holds the power, and the power he holds is incredibly sinister.

You better watch out
You better not cry
You better not pout
I’m telling you why
Santa Claus is coming to town

Now, try (and unless you don’t recognise the song it’ll be hard) to read this as a threat. Because it is a threat. Try reading it out loud through gritted teeth. A bit extreme maybe, but the point is clear: you, child, had better start behaving in a manner that I consider to be good because an extremely powerful man is about to arrive.

He’s making a list,
Checking it twice;
Gonna find out who’s naughty or nice.
Santa Claus is coming to town

That’s right kid, you’re going on a list. And this is a black and white kind of affair; you’ve either been naughty, or you’ve been nice. There is no in-between. There is no process of appeal. There is only Santa’s judgment. Oh, and just in case you thought you had any way of hiding from the man with the big white beard:

He sees you when you’re sleeping
He knows when you’re awake
He knows if you’ve been bad or good
So be good for goodness sake

That’s right; every second of every day, Santa is watching you. So be good for the sake of being good, because that is behaviour that Santa has been created to reward; actions that appear to be good. Niceness, that bland little alias for obedience to status quo.

And here’s what you get if you’ve been naughty (NB Tony is one of my cats. Yes, it’s a ridiculous name for a cat).

I labour this point because I consider it the principle point. Every time a parent tells their child ‘carry on like that and Father Christmas won’t be visiting this year’ to get them to obey, a vital message about society is being conveyed: obedience is good, disobedience is bad. Yet so often the people who hold social power and demand obedience are not people whose motivations and actions are all that good.

And of course, Father Christmas grants parents the vital tactic of deferred authority. It’s not me, it’s him; I’m just the messenger. Because the kids need to know how to get on the good list right? And they can’t ask Santa directly, so they need parental cues on what counts as good and what counts as bad. So the parents get to enjoy the authority conveyed by service to a higher power, at the same time as the comfort of delegated responsibility; it’s easier to implement a higher authority’s rules than to own and assert one’s own needs.

Remember, young kids think this stuff is real. They literally think that actual Father Christmas will punish them for being on the naughty list by withholding presents and only reward them with presents if they get on the nice list. Doesn’t that directly assert from day one that the child’s own nature is to some degree inherently unacceptable?

So, Father Christmas is a patriarchal symbol because he perpetuates male dominance of power. He is a symbol of parental tyranny because his function is to give parents an unaccountable deferred authority with which to condition children into obedience.

2) he is a capitalist symbol of social control

If you have kids, and do the Father Christmas thing, I’ve possibly just offended you deeply by implying that you are a tyrant. Soz. Most parents aren’t tyrants, and don’t use Father Christmas as an overt tool of tyrannical control. Unfortunately though, the effect remains the same; however benevolently Father Christmas is presented, he is still the arbiter of the getting of presents.

And there is one very good reason why Santa retains this power: commerce. The christmas shopping period is the retail occasion of the year. There are shops whose existence throughout the year depends on Christmas trade. That is, the profit they make in the run up to Christmas offsets the losses they make in the rest of the year. Watch in the New Year for businesses going into administration as a result of holding out for the Christmas revenues that didn’t come.

That’s a pretty powerful social pressure. Christmas is a vital economic stimulus; profits have always been at stake, meaning the interests of powerful people (it’s that 1% again!) are at stake, meaning a powerful controlling symbol is needed. That’s right, Father Christmas is in the pay of the corporate elite. This makes absolute sense; only multinational corporations can rival Santa’s ability to deliver presents worldwide in a single night without falling prey to the contradiction of timezones.

The point here is this: the vested interests that give the symbol of Father Christmas its power are corporate and motivated by profit. Just look at where the activity is focused; people queue to get into shops, empty the shelves of food, and fight each other to make sure their kid gets the must-have present of the year.

Now stop, breathe, and ask yourself: why does this happen? I’m serious, what’s the motivation here? Wasn’t the 25th December Christ’s official birthday last time I checked? For the record, I’m neither Christian nor driven by the need to labour the ‘but the Christians stole it from the pagans’ angle. All of that is somewhat irrelevant when we take gestalt’s here and now perspective and ask:

What is the need that mobilises all this action now?

My conclusion is that profit drives this action. Generally speaking, I do not observe families benefiting from Christmas. I do observe parents feeling an immense pressure to give their kids what they want for Christmas. I observe advertising telling kids what they should want for Christmas. I observe a level of activity that can only be described as manic taking place in retail centres; not a rush to attend church, not a desperate flailing to go home and play board games with family, but a frenetic stampede to buy stuff. And it’s all stuff that is largely not needed other than to live up to a collective idea of what Christmas should look like.

And Father Christmas is the lynch-pin. For one thing, he’s the symbol that many of us grew up with, so he now sits active in the psyche of many adults wanting to give their children the kind of Christmas they wanted and didn’t get (or worse, the sentimentalised Christmas they remember but that never actually happened). More importantly, he ensures that no parent is in any doubt that Christmas is about giving your children presents.

When your kids go back to school, the question will be: ‘what did you get for Christmas?’. Not, ‘don’t you think it’s ironic that our Government is forcing another 100,000 children into poverty at a time of year when we celebrate Christ being born in a stable?’. Not, ‘did you enjoy spending time with your family over the holiday period?’. But, ‘what did you get for Christmas?’. Because kids are authentic (that is, they respond to the actual situation) and they know what Christmas is really about.

So, Father Christmas is a capitalist symbol because he is the jolly bearded face that demands you shop like a maniac for the benefit of the wealthy few. He is a symbol of social control because his image demands action that is hard to disobey without attracting social disapproval.

3) he is an agent provocateur for the Coca Cola corporation

Holidays are coming, holidays are coming, holidays are coming…

There’s a nice overview of the history of Santa Claus on wikipedia. A brief synopsis of this would be:

Father Christmas started out life as a pagan symbol of the coming of spring. In time, this merged with the legend of a Christian Saint famed for making anonymous gifts to the poor. Under the influence of Victorian sentimentalism, the erstwhile variable form of Father Christmas crytsallised into the kindly old sleigh riding, present bearing bearded one we know today. Finally, Coca Cola popularised the red version.

Coca Cola say: “though some people believe the Coca-Cola Santa wears red because that is the Coke® color, the red suit comes from Nast’s interpretation of St. Nick”. A more accurate way of putting that would be: “some people believe the Coca-Cola Santa wears red because that is the Coke® color; this is true”. After all, the decision to use Nast’s interpretation of St. Nick will have included the rationale “it matches our corporate colour”.

And in the spirit of the imperialistic urges of multinationals, this corporately sponsored Father Christmas has so homogenised the celebration of Christmas, that a natural abundance of diversity in portraying the spirit of mid-winter has been largely wiped out. That’s right, Santa Claus is also a genocidal maniac.

He’s probably not really an actual agent provocateur though, I just put that bit in because it sounded good.

And finally…

4) FATHER CHRISTMAS DOESN’T EXIST!!!

Even ignoring the fact that our entire society collectively puts effort into lying to children, forcing inquisitive children to remain in the lie, and using social pressure to force parents into maintaining the lie, we are left with an undeniable truth:

The guy in the red suit sneaking around my home in the middle of the night is a burglar.

Upstanding pillar of the community, Secretary of State for Justice Ken Clarke says I can stab people for being burglars. In the light of the level of menace this man represents to society at large (Santa Claus, not Ken Clarke, though I’ll leave you to make your own judgment in the latter’s case), I am therefore justified in ensnaring him in jaws of merciless steel should he cross the threshold of my humble abode.

And that, ladies and gentlemen, is why I set man traps for Santa.

HAPPY HOLIDAYS EVERYONE!

Psychotherapy in a time of political crisis

I’ve been wanting to write a lot more about the overlap between politics and psychotherapy these last few weeks. Recent world events have got me thinking more about the impact of transpersonal processes on the emotional wellbeing of the individual. This was brought home to me by a number of traumatic images of police brutality coming out of the Occupy protests. Here I am, able to make contact with a situation unfolding on the other side of the world, immediately in contact also with a sense of powerlessness. I think that the advent of web 2.0 has the power to support individual contact with forces that, even ten years ago, were far more indirect and background than the dominating figures they are capable of becoming today.

This has huge implications for doing therapy. Gestalt in particular, with its here-and-now focus, and a field theoretical outlook that specifically demands we address the context within which the individual exists, has a role to play in supporting individuals in withstanding exposure to otherwise quite overwhelming social forces. I have a post (to write!) on different levels of self that will be a useful map for exploring this.

In the meantime, I’m reminded of what Fritz and Laura Perls had to say about this area:

“As you know, there is a rebellion on in the United States. We discover that producing things, and living for things, and the exchange of things, is not the ultimate meaning of life. We discover that the meaning of life is that it is to be lived, and it is not to be traded and conceptualized and squeezed into a pattern of systems. We realize that manipulation and control are not the ultimate joy of life.”

Fritz Perls, Gestalt Therapy Verbatim, p3.

“You know, I think the work that I am doing is political work. If you work with people to get them to the point where they can think on their own and sort themselves out from the majority confluences, it’s political work and it radiates even if we can work only with a very limited number of people. We choose the kind of people to work with, who again have influence on others. That is political work.”

Laura Perls, Living at the Boundary, p17.

Fritz and Laura Perls both left Germany as Hitler rose to power. After some years in South Africa (where Fritz wrote Ego, Hunger and Aggression, one of the tributaries that later flowed into Gestalt Therapy: Excitement and growth in the human personality), they came to America. I think Laura captures the fundamentally political nature of their work more elegantly than Fritz, though Fritz communicates the vibrancy of that stance with greater energy.

My overall sense is this: gestalt therapy is about becoming your self, an individual in community with other individuals. That doesn’t mean the corporate reflection of individuality espoused by adverts that seek to sell various brands of individuality to mass markets without any sense of irony. It means something more like Jung’s individuation process, in which each of us becomes increasingly unique with each assimilated experience and moment. Interestingly, this growing idiosyncracity leads not to isolation but to contact: there is no contact with others in a group that has merged into a single entity.

I really like Laura’s phrase ‘the majority confluences’. When Laura refers to ‘majority confluences’, she means the social and cultural choices and actions that we go along with through either automatic agreement or non-choice. Following the crowd in a kind of hypnotic unquestioning state is our automatic agreement to the majority will. Allowing a situation to unfold that one in theory opposes yet to which one chooses not to choose to object is non-choice. The existential commitment of gestalt therapy is this: you have no choice but to choose; not-choosing is itself a choice.

Confluence is a modification to contact that involves erasing the contact boundary and merging with the other. There must be a boundary separating you and me in order for us to be in contact. If I can merge with you, we can exist as a single entity, no boundary between us, no contact. Clearly I can’t merge with you in any literal, physical sense. However, we can merge our ego boundaries, our sense of ourselves, and slip into a strange us-world in which we maintain a boundary around us and all contact with others is ‘us’ in contact with ‘them’. Re-read this paragraph with an aliveness to how you feel as you read all those ‘we’, ‘us’, and ‘our’ statements. It gets me feeling kind of trippy.

This is at once the triumph of safety in numbers and the horror of the herd mentality. It is also an instrument of control that ensures the individual is subsumed into the group.

Gestalt therapy was formed by people who had fled Nazism. In the wake of World War II, ‘majority confluences’ held connotations of fascism, communism, nationalism and other isms against which Ferris Bueller would advise. However, these isms did not and do not form in a vacuum; they are latent in all cultures, emerging as they do out of the interplay between individual and group, personal and collective.

Psychotherapy is an innately political force all the time it encourages an active questioning of that which is socially accepted as being the way things are or should be. This questioning isn’t the blind rejection of rebellion for its own sake but the critical questioning that equates to chewing one’s food before swallowing; or indeed, at least looking at what’s on the fork before putting it in one’s mouth.

If there are two modifications to contact that are the traditional villains of gestalt therapy, then they must be confluence and introjection. Fritz in particular had a visceral intolerance for confluence and an almost pathological insistence on contact. That’s understandable considering how mass confluence in Nazi Germany supported the atrocities of the holocaust.

Introjection is different. This is the uncritical swallowing of the attitudes, beliefs, and ideas of others; usually society at large, parents, teachers, and authority figures generally. Confluence makes a nice safety blanket for introjects, and this is visible whenever someone speaks out against a majority confluence. When feminists, for example, point out that there’s no reason why a woman should perform this or that expected social role, they question introjects that hold powerful social confluences in place; confluences that ensure that men retain a position of privilege and power in society, and that the women who support those men gain a complementary social privilege.

The woman who has accepted such a social role, not out of genuine choice but as an adaptation to patriarchy, is suddenly brought into contact with her situation. Now she must fight to silence the feminist so she can return to the comfort of confluence, or question and extract herself from her situation and risk losing the advantages that have come with adaptation.

As for the man; well, as a man I come up against this struggle regularly and can acknowledge that it is one of the most singularly uncomfortable experiences to realise that I enjoy a social position of privilege (however under-privileged I might otherwise feel!) over another simply on the basis of my gender (and that’s before I consider the privileges that come with also being white, able-bodied, and well-educated).

And worse, that I can’t see that privilege, on account of how basic it is to my place in society. So my position becomes similar to the adapted woman’s position: I can fight the feminist and protect the patriarchal confluence that affords me the privileges I either deny or claim as natural right. Or, I can come into contact with my situation, and also risk losing the advantages that come with playing along.

The potential political power of psychotherapy is vast when I consider that political discourse emerges from exactly the subjective interpersonal themes that are the substance of therapy. So your parents force-fed you a work ethic, the yoke of which you now struggle to throw off. Yet that work ethic is reinforced as a transpersonal force by a society and Government that values the individual only as an economic unit of productivity. Question that work ethic, and you question society itself; and society doesn’t much like being questioned.

Field theory allows the gestalt therapist to ask: to what extent is this or that feeling or action or behaviour a way of embodying or tolerating or otherwise creatively adjusting to the individual’s wider context? Is that young person’s eating disorder the family’s way of manifesting a systemic or transgenerational problem? Is that other person’s psychosis society’s way of finding someone to carry the madness the rest of us can’t accept as our own? Is it any wonder that the survivor of sexual assault blames herself by saying she should have done something to stop it when that is exactly the defence her attacker will use if she goes to court?

In this respect, the two most political words in the English language are probably ‘no’ and ‘why’. Against confluence: ‘no, I will not be part of this’. Against introjection: ‘why must this be so?’. If psychotherapy does nothing else, it empowers people to say both; and that is both simply and profoundly political.

Occupy therapy (a petition against therapeutic hegemony)

There is currently a petition running to “reform the NICE guidelines and end the bias towards Cognitive Behaviour Therapy (CBT) in the IAPT programme”.

I am supporting this because, metaphorically speaking, 1% of the UK’s Counselling and Psychotherapy profession is in danger of enjoying more influence over the delivery of mental health services than the remaining 99% combined. I have no official figures to back that up with, but you have to admit it sounds good!

Ok, so that’s mostly artistic licence; however, I’m not making the comparison lightly. Nor do I really have much beef with CBT in itself; gestalt integrated cognitive and behavioural approaches to therapy back in 1951 (see Perls, Hefferline and Goodman‘s Gestalt Therapy on working through introjects cognitively (pp189-210) and behavioural experimentation (pp14-17). Maybe I’ll write more on this at some point, but in essence, I think that good gestalt therapy already encompasses much CBT).

My objection, along with the authors and co-signatories to this petition, and the people involved in the Occupy movement, is the concentration of power into a small minority. And that is what is currently happening with respect to the provision of officially sanctioned therapy services in the UK, as CBT is promoted as the evidence-based therapy of choice. And this despite the relevance of the measures underpinning that evidence-base being questionable, and a lack of longitudinal and follow-up studies. As well as the inherent logical flaw in claiming that any form of therapy has an evidence-base for efficacy in treating conditions such as depression, when there isn’t really any solid professional consensus about what depression actually is.

I support the need for evidence-based therapy and for research into counselling and psychotherapy generally. If we are to avoid a bizarre therapeutic turf war between Great Houses (my theory’s harder than your theory!) then counselling and psychotherapy as a profession needs to live up to its own values and support the part that research plays in developing reflexive practice. But that means developing a research tradition that is appropriate to the area under research. Which must include philosophical exploration into what can realistically count as a measure by which efficacy can be assessed, if indeed such a thing is possible. Remember, all information is potentially evidence; the term ‘evidence-base’ merely means an amassed body of information used to argue for a specific position. It does not constitute a proof.

In my experience, there is no such thing as the cure-all magic pill when it comes to the human condition. There is great danger in pinning so much hope on CBT, and it is the same danger that applies in any idealisation of another. Sooner or later, the idealised other will fail to meet the impossible ideal of perfection and fall from grace. At which point, the idealised other becomes demonised. That is the inevitable fate of any therapy that is pointed to as the answer to every individual’s problem. If gestalt therapy were being lauded in place of CBT, I’d be arguing the same thing; probably more passionately, as on top of my general feeling that therapeutic efficacy has more to do with the relationship than the theory involved, I’d also see the risk to myself as a practitioner of an idealised theory.

Consider my argument to be one in favour of biodiversity in the therapeutic field and you’ve probably got it in a nutshell. I won’t demand that you agree with me. Rather, I present you with my opinion, a petition, and an invitation to consider your own position on the issue.

You’ll find the petition here.

Therapeutic group for carers at The Harbour, Bristol

The Harbour is a Bristol-based charity that “provides free counselling and psychotherapy to people affected by a life-threatening physical illness”. They’re based in central Bristol, with convenient (pay and display) parking very close by. I’ve visited their premises before while on the hunt for practice rooms and it seems like a comfortable place for therapy.

They are currently spreading the word about a therapeutic group they’ll be starting in early 2012. This is aimed at people who are looking after someone with a life-threatening illness. It will run on a once-weekly basis for six months, and you can download a pdf flyer here: carers group flyer.

I believe The Harbour opeates from a psychodynamic perspective, so assume the group will run in that same vein.

As other gestalt writers have noted Fritz Perls came to believe that one to one psychotherapy was defunct, and that group therapy represented the next evolution in the therapeutic endeavour. Then again, in his final writings, Perls also declared group therapy defunct, believing the therapeutic commune he was setting up near Esalen was the next evolution in the therapeutic endeavour. Generally speaking, I take these sorts of declarations with a pinch of salt, especially when the person making them is essentially saying ‘the way I used to do things is defunct, the way I am about to do things is the way forward for us all’.

The beauty of the therapeutic group is that it builds a sense of community and interpersonal support that is very different to the individual therapy situation. I think both forms of therapy are good for exploring different things; group therapy is particularly good for exploring ‘the self in the system’, that is, how I as an individual relate to us as a group.

People who care for someone with a life-threatening illness are often quite isolated in their experience, especially considering how death-avoidant British culture tends to be. Speaking for myself, I might know that someone is caring for someone with a life-threatening illness, but I can’t pretend to know what that’s like in practice as it’s not anything I’ve experienced personally.

As a therapist, I would be able to empathise and explore the issues and so on. However, people also need a certain amount of ‘oh tell me about it, I dealt with something like that last week’ that is really more about connecting on a social level than on a therapeutic level; people who have good enough levels of support around them don’t generally come for therapy.

For further information about this group, contact details are on the flyer and the website.