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Archive for June, 2011

At some point in my life, I read or heard someone say that the key to improvisation is rehearsal. This, I opined, was idiocy. I mean seriously, improvisation is making it up as you go along, right? Well how the hell do you make something up as you go along when you’ve already rehearsed it? Oxymoron, I say, oxymoron!

Like some obscure kind of abstract dinosaur thing, that little episode passed away and settled on the seabed of my memory, destined to be covered by years of silt until, crushed beneath all that pressure, it mulchified (technical term) itself into a thick black viscousness far beneath the earth.

Scene change.

The founding gestaltists were influenced by Zen Buddhism. In the book Concentration and Meditation, Christmas Humphreys describes Buddhism as a long, well-worn path to the top of the mountain. This is the teachings as laid down by Buddha, intended to be a safe and consistent journey that needs only dedication to complete. By contrast against the background of this metaphor, he then describes Zen as a vertical sprint up the mountain side, a fearless dedication to taking the most direct route to enlightenment at any given time.

This, roughly speaking, is how I would sum up the difference between gestalt and the humanistic/existential therapies. Working in the here and now, following what is being directly experienced in the moment, therapist and client strive to cut through to the heart of the matter; we sprint up the side of the mountain.

One of the key teaching media in Zen is the koan, a brief parable-like story whose main purpose is to short-circuit logical thought in order to provoke an insight that can generate anything from an experience of satori to fullblown enlightenment.

The closest equivalent to the koan in Western culture is, in my opinion, not the parable but the joke. A parable is logical, usually relying on clever analogies that, as symbolic as they might be, translate well. The whole point of a parable is to convey a moral lesson (Zen Buddhism, on the other hand, isn’t concerned with moral lessons; in Zen, if morality gets in the way of enlightenment, you kill it just like you’d kill the Buddha).

A joke, on the other hand, isn’t funny if you have to explain it, just like a koan doesn’t provoke insight if you have to explain it. The experience of laughter in getting a joke is an exact parallel to the experience of aha! in getting a koan; and in both cases, you either get it or you don’t.

Koans frequently feature the exploits of Zen masters of the past. In this respect, I think a large part of engaging with koans is about rehearsing for enlightenment, a state that can’t possibly be known before it happens. Like the stand up comedian who rehearses routine after routine in order to be able to throw away the routine and respond spontaneously to the audience, I suspect the Zen student is given koan after koan precisely so they can eventually throw the form of the teachings away in order to directly grasp insight. Rehearsing routines helps the comedian get a felt sense of raw comedy; rehearsing koans helps the Zen student get a felt sense of raw insight.

Many people have reduced gestalt therapy to the impressive techniques they have seen master gestaltists use in workshops; this is the critical error of mistaking the finger for the moon. In training, the purpose of such techniques is to provide a rehearsal structure that can later be thrown away; the purpose is to help the trainee get a felt sense of the therapeutic moment. The purpose of rehearsing two chair work, for example, isn’t to get really good at a specific technique, but to gain a felt sense of what it’s like to get two or more aspects of a person to engage in dialogue with each other and work towards reunion. Sometimes, setting up a two chair experiment actually prevents that from happening!

All of these rehearsals lay down dinosaurs on the seabed of self to be covered in silt and mulchified by the years. Then, one day, you set up an oil rig, dig down, down, down into your crust, and GUSH! you’re bathing in the black gold of wisdom.

And that’s how I know that Buddha’s first words as an enlightened being were:

Ohhhhhhhhhhhhhhhhhhhhhh, I seeeeeeeeeeeeeeeeee!

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Once upon a time, I was a philosophy student. Now I might be somewhat biased, but in my opinion, a philosophical training is an optimum preparation for psychotherapy training. This is no surprise when you consider that philosophy originally arose as an expression of humanity’s need to answer exactly the kinds of Big Questions that sit at the heart of much human suffering: how do I know the world is real? Is there life after death? What is the meaning of life? What *is* life?

For the ancient Greeks, philosophy was already a form of therapy. I translate philosophy as love of wisdom, philo being the love part, and sophia being the wisdom part. It can be rendered as love of knowledge, but I think this fails to capture the point of engaging in philosophy in the first place.

Philosophy isn’t about knowing stuff; it’s about becoming wise. If philosophical insight doesn’t lead to an enriched sense of being, then it is a grape that has withered on the vine. One of my most painful experiences during my studies of philosophy was realising that a disturbing proportion of academic philosophy was constituted of sour grapes! The main problem is that philosophy has been split in the West into the analytical or anglo-american tradition and the continental tradition. The former focuses on intellect, the latter on intuition.

In my opinion, wisdom is a fusion of the two. Possibly a discussion for another day.

One of the unique challenges about being a philosophy student is that every other student thinks they know what philosophy is. This invariably gets expressed in the following dialogue:

Other: So what are you studying?
Me: Philosophy.
Other: Ahhhhh, but if a tree falls in a forest when no one’s around does it make a sound?
Me: No, it doesn’t.
Other: … I need to go over there now.

There is a good reason for asking a question as preposterous as ‘if a tree falls in a forest when no one’s around does it make a sound?’. Which, of course, is to provoke the student into thinking about their assumptions. The point in this case being that sound is a sensation, and that sensation is created by the creature that experiences that sensation. When a tree falls in the forest, it makes vibrations in the air; these vibrations need to be converted into the experience of sound by one with ears to hear. If Alfred the Evil Scientist were to eradicate all beings capable of hearing from the universe, there would be no such thing as sound.

The point of the thought experiment is to provoke serious thought about the nature of sensation, and this is very important for the practice of psychotherapy. Has it occurred to you, for example, that absolutely everything you experience is your own creation? Seriously. I can hear a car’s engine right now. That means that vibrations in the air have reached my ear, vibrated some sensitive bones, rippled through some fluid, been converted into electric impulses, then been converted into the experience of sound by my brain.

Question: where is the sound of the car’s engine located?

Answer 1: In the car’s engine.
Answer 2: In the stretch of air between the car’s engine and my ear.
Answer 3: In my ear.
Answer 4: In my brain.

In a way, sound is located in all four places because all four places are needed in order for sound to be possible. The experience of sound, though, is located in my brain. I can locate with a good degree of accuracy where the source of the sound is, and experience the sound as existing over there. But that’s projection; I experience as coming from something else what is actually being created by me. Yes, the car’s engine is vibrating the air, but the form the experience takes is my creation. Hence why we can only hear sound waves within a certain range of frequencies; our auditory equipment has physical limits that shape what it is possible for us to experience.

Vibrations are not sound; vibrations are one causal factor in the creation of sound. If you experience sound in your dreams, where are the vibrations? Nowhere; you create the experience of sound.

This is why the gestalt idea of need configuring the field is so important; we create our experience of our environment. The experience we create is heavily shaped by our needs. As we make our way through the world we live in, there is an infinite scope for what could come to our attention. So why is it that we focus our attention on this thing here rather than that thing over there? Why am I writing a blog post about the link between philosophy and psychotherapy rather than some other subject? Why am I writing a blog post rather than doing one of a myriad other things that are possible for me right now? And so on.

The fundamental lesson of the tree falling in the forest is the insight that I create my experience of the world. Now, if you really want to explode your mind a second, just take a look around you. Everything you’re seeing is your own creation. Light has entered your eyes, impacted your retinas, been converted into electric impulses that have fired along your optical nerves into your brain where you have converted those impulses into the experience of sight.

The reason we get such a sense of awe and majesty when we stand in a high place and see a sprawling panoramic is, I think, because at some level we know that we are creating that panoramic for ourselves. Every experience we have is our own creation. Which means that the possibilities available to us at any given time are also our own creation. Philosophers get lost in academic wrangles about technical points because that’s what they need to do to sustain an academic career (publish or perish as the saying goes). The real purpose of philosophy is to be a vehicle by which, through contemplation, we arrive at insight, wisdom, and peace.

That said, every insight raises more questions. Such as, if I create my own experience, then what is the nature of the external source of that experience and how can I know that there is one? Gestalt’s answer is that all experience occurs at the contact boundary between my self and my environment. No vibrations, no sound. No creature capable of hearing, no sound. Not only do both exist together, but one cannot exist without the other. The very idea of vibrations in the air necessitates the existence of something that can conceive of such a notion. In order to conceive of such a notion, some phenomena must provoke the conception of such a notion. The two cannot be pulled apart.

Did you ever do the bar magnet and iron filings experiment at school? You take a bar magnet and place a piece of plain paper on top. Then you sprinkle iron filings over the paper. This makes the bar’s magnetic field visible.

This provides an excellent example of the contact boundary because it’s only possible to know of a field by giving shape to it, and the shape the field takes is determined in equal measure by the nature of the field and the nature of the medium the field is influencing. The two make contact and produce an experiential skin. And that gives rise to the gestalt concept of contact. Nothing has a ‘true nature in and of itself’ because nothing exists in and of itself, everything exists in, and is shaped by, some context.

Even the laws of physics fail to express the true nature of an objective reality independent of human experience. The very idea of a human being defining something that is independent of human experience is actually quite amusing because the very act of definition demonstrates the subjectivity of the thing defined; we must necessarily define it in human terms.

And that means that reality, human reality, isn’t just relative; it’s relational.

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I’ve been blogging away for about six months now, and have decided that it’s high time I named a principle after myself as my enduring contribution to psychotherapy. I’m not entirely sure how I arrived at what I arrived at (which, as you’ll see, is a rather neat case in point) but it was fun getting there.

I was thinking about the seemingly diametrically opposed focuses of process and outcome in psychotherapy. I think of therapies like CBT as being essentially outcome focused, the logic being ‘so you suffer from panic attacks? Right then, we’ll find a way of stopping those damn panic attacks!’. A process focused therapist might well scoff at this attitude. I think of therapies like humanistic person-centred as being essentially process focused, the logic here being ‘so you suffer from panic attacks? *therapist looks warmly at client whilst embodying the core conditions*’.

The two approaches are, of course, focusing on two completely different things. The CB Therapist (btw, please can everyone stop saying CBT Therapist? What you’re saying is Cognitive Behavioural Therapy Therapist; my brain automatically expands the acronym and it causes me physical pain! Thank you) wants to solve the problem (outcome), the HPC therapist wants to explore the problem (process).

In HPC, the idea is that the panic attacks are something the person needs to experience in some way. Roughly speaking, the person, driven by their actualising principle to develop and grow, encounters some deep-rooted obstacle to that growth, resulting in panic attacks. By supporting exploration of the problem, the HPC therapist is supporting the person’s growth with the belief that the actualising principle will eventually win out, with the person spontaneously discovering their panic attacks to be meaningful expressions of their humanity. This may or may not result in release from panic attacks, but will certainly lead to an expanded consciousness.

By contrast, in CBT, the idea is that panic attacks are an undesired consequence of the person’s thinking and behaviour. This person wants and needs to change their thought and behaviour patterns in order to gain release from the suffering of panic attacks. The goal is to stop the panic attacks, and this is achieved by identifying the problematic thought and behaviour patterns and changing them to non-problematic thought and behaviour patterns. Successful CBT ends the panic attacks, unsuccessful CBT doesn’t end the panic attacks; expanded consciousness is beside the point.

If you’re HPC or CBT trained and are currently frothing at the mouth at how badly I’ve misrepresented your field, please do correct me; I reserve the right to disagree with your interpretation of your own area of practice for entertainment purposes.

Gestaltists will most readily ally themselves with the process focus but to be honest I think gestalt actually moves between the two, with the majority of the time spent with a process focus. The fact that I engage in creative experimentation in my practice places at least some of what I do in the CB camp. Experiments, by their nature, are a behaviourist approach to therapy. And sometimes, they have an outcome focus.

If I was working with panic attacks, for example, an experiment might be to re-create a low-level panic attack situation in the therapy room (like reading a passage from a book to an imagined audience). The point of this in gestalt is to gain direct access to the feelings involved in a safe environment instead of being two steps removed from the issue by talking about what happened last week (and of course, I wouldn’t do this with someone if I felt they weren’t going to be able to re-stabilise afterwards). This can be process focused; the experiment brings powerful feelings into awareness and we see where those feelings take us. Or this can be outcome focused; the experiment serves as a training ground for building tolerance for the panic-attack situation (it becomes exposure therapy really).

‘Yes yes, but what about this principle you’ve invented?’, thanks for the reminder…

Heisenberg’s uncertainty principle postulates that:

“The more precisely the POSITION is determined, the less precisely the MOMENTUM is known”

Roughly speaking, determining the position of a particle in space is difficult because all things are in motion relative to each other. So the momentum of a particle is a function of its spatial relationship to other particles (note here the similarity to gestalt’s field theory where behaviour is a function of a person’s environmental/situational relationships).

Consider the earth orbiting the sun. We know the speed with which the Earth orbits the sun because we take the sun to be a fixed point. But of course, the sun is also hurtling through space; it is only a fixed point relative to the planets that orbit it. The moon orbits the earth at the same time as the earth orbits the sun, so how fast is the moon travelling and in which direction? It’s ok, my mind just melted too.

My argument is that the same uncertainty applies to process and outcome in psychotherapy, hence The Staff-Tow Uncertainty Principle:

“The more precisely the OUTCOME is determined, the less precisely the PROCESS is known”

As a guy I once knew used to say, ‘you can have yan or t’other but ye anae avin’ baeth’.

This doesn’t mean that one factor is better than the other, only that you can’t have a full and vibrant awareness of both at the same time. And that’s because the sheer scope of possible outcomes for any given process is huge. In order to arrive with any kind of probability at a pre-determined outcome, the process has to be geared towards that outcome, meaning that the possibility of all other outcomes is closed off as much as possible.

On the other hand, focusing on process, on what is happening right now, opens up progressively more outcomes that themselves become part of the process until there is only process and no outcomes at all. Again, this is relative; in order to define something as an outcome, we have to create a fixed state, and the illusion of an outcome as a final state of affairs.

Strictly speaking, stopping panic attacks only counts as an outcome if we arrive at a point where the person never has a panic attack again. Hence, the outcome is relative to the process of a person’s entire lifetime. And there is one very good reason why, as unpleasant as a panic attack is, the removal of panic attacks is an undesirable outcome; survival. I would quite like to have a panic attack in a life threatening situation if that panic attack mobilised me into running away and surviving.

We can become more precise about our outcome: no more panic attacks in such and such a situation. In which case, we become less precise about the process of being human of which those panic attacks are an expression. We can also become more precise about the process: panicking is a fear reaction to certain environmental factors that were real once but are now largely internalised and projected onto similar situations in the present and actually have as many pros to the individual as cons. In which case, we become less precise about the outcome we’re aiming at.

In gestalt theory, this would be an example of need configuring the field. A desired outcome is our need, so we arrange our perception of our current situation around that need; hence, we are most aware of aspects of our situation that will bring us closer to our desired outcome, and lose awareness of other aspects of our situation. This is a good thing, by the way, because if we were fully aware, moment to moment, of every aspect of our immediate situation, we would quickly lose ourselves in an overhwelmed state in which we would be unable to selectively block out environmental stimuli.

Just like position and momentum, outcome and process are two ends of the same continuum. I think of this as having an outcome/process dial. A CB therapist most likely has that dial way in the outcome direction, whilst the HPC therapist will be way in the process direction. My personal preference as a gestalt therapist is to change my dial’s position depending on the therapeutic situation. Generally speaking, I enjoy being more on the process side than the outcome side. But just try having a traumatic flashback in my therapy room and see how quickly I turn that dial to outcome!

Outcome and process are two ways of focusing the same experiential lens; awareness. Awareness is often likened metaphorically to light (which is apt bearing in mind that light can be considered a particle or a wave depending on the situation). If we use the outcome/process dial to change the focus of the light of awareness, then maximum outcome is going to be highly focused like a laser beam and maximum process something more diffuse like twilight.

Try out this metaphor for yourself. Imagine a dial that goes from (maximum process) 0 to 100 (maximum outcome) with an exact halfway point at 50. What is your dial turned to right now? Where do you habitually keep your dial? What range of settings feels possible/impossible for you? Where’s your comfort zone?

For me, the ideal isn’t to find the right setting on the dial. The ideal is to be able to change the setting from situation to situation by choice; and that is organismic self-regulation.

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Update (18th September 2011): I’ve noticed that this post gets a regular number of visits from people doing web searches that feature ‘frozen face’ as a search term. If you have reached this post in this way, I would be interested in your reaction to what you read here, and how (if at all) it relates to the reasons for your search. E-mail me at: simon@silvercatpsychotherapy.co.uk

I was at a training event recently, and a colleague described someone who had trouble with their facial expression. They had a kind of set expression on their face that they found difficult to change deliberately. This was in relation to a discussion about the link between facial expression and emotional attunement, particularly in terms of empathy, and it reminded me of my own experiences of what I’ve tended to refer to as ‘frozen face syndrome’.

I’d like to put all that together here, and will start with a brief memory:

I’m sat with a very expressive friend, and she’s telling me about something that happened between her and someone else a couple of days previously. As she’s telling me, I’m listening intently and finding something strange. I realise that her eyes darting around as if scanning my face. Soon after that, she exclaims, ‘well respond then botox boy!’.

Sometimes, life has an interesting way of bringing things into my awareness. Previous to being named botox boy, I hadn’t been aware of my general lack of sensation in my face. As I reflected on this encounter, I became increasingly aware that my face felt numb and actually quite stiff, as if the muscles were literally frozen. I realised that I found it difficult to change my facial expression deliberately, and more, realised that I mostly wore a single, quite blank, expression on my face for most of the time.

I’ve already blogged about how I view emotion as the necessarily physical expression of inter- personal need. The place of facial expression within this is as the (wait for it, wait for it) interface between emotional systems; facial expression communicates emotional need and understanding. The discussion I mentioned above was about the part played by facial expression in attuning to and empathising with the emotional experience of another person.

In 1975, Tronick et al devised the still face experiment in which mother and infant interact normally for a while, before the mother presents a totally blank face. Baby tries to get its mother to respond with facial expressions but eventually grows anxious and distraught. The implication for attachment theory is that baby needs to be able to ‘read’ its caregiver’s facial expression in order to create a stable attachment.

More than that, facial expression communicates to someone else what’s going on within our own emotional system. To go back to that handy interfacing word, you could say that faces allow nervous systems to communicate with each other in quite a direct way about emotional sensation. And that’s an important aspect of empathy; being able to gauge the emotional sensations of another.

So what’s the deal with frozen face syndrome? Think Poker Face; the whole point is to not be emotionally read. Interestingly, in looking at the Poker Face lyrics, whilst the opening stansa isn’t exactly W.B.Yeats…

Mum mum mum mah
Mum mum mum mah
Mum mum mum mah
Mum mum mum mah
Mum mum mum mah

… there’s an awful lot of mum going on (altogether now in your best Austrian accents, ‘tell me about your mother’!). Only a half-jest, as even a parent in a state of rage is less frightening for a pre-verbal child than a parent with no discernible emotional state. Thinking about it, the same is probably true for adults too; I tend to be more frightened by the ‘cold blooded killers’ in films who kill with no expression on their faces than the ones with faces contorted in hate or rage.

The more obvious lyrical meaning comes from the chorus:

Can’t read my, can’t read my
No he can’t read my poker face
(She’s got to love nobody)
Can’t read my, can’t read my
No he can’t read my poker face
(She’s got to love nobody)

The whole song being of the hiding behind an unreadable mask whilst manipulating others kind of affair. Incidentally, I heard a guy doing an acoustic cover of this song a few weeks ago; the slower tempo and unglossed production made the whole thing sound like a beautiful ballad about emotional isolation.

My own experience of working with my frozen face in therapy was one of emotional rediscovery on two fronts. On the one hand, I found that I was Poker Facing, and spent some time exploring my own anxiety about having other people see me express myself emotionally. On the other hand, my frozen face helped me to place specific emotions into a kind of stasis so I could avoid experiencing them.

I started massaging my face to help get some mobility back in the muscles, and gurning as ridiculously as possible at mirrors. If all this frozen face stuff is resonating with you, I’d highly recommend experimenting with those two activities. And if you get the paranoid idea that someone is watching you through the mirror, then don’t worry, I went through that stage too. There is someone watching you through the mirror; the disowned critical part of yourself that attacks you for expressing whatever it is you’re holding back (I’m focusing on emotional expression here, but freezing your face could be about holding back a whole host of things).

The thing to remember is that freezing your face involves using voluntary muscles to counter-act automatic muscle action; the voluntary action has just been held in place for so long that it’s become automised and structural. This is what Wilhelm Reich originally called character armour; using voluntary muscles to create stiffened muscle structures that protect the self from something (we tend to brace ourselves for impact after all). Gestalt therapy incorporated this idea into its general approach to bodywork, reconceptualising character armour as a form of creative adjustment. Freezing facial muscles is a great demonstration of retroflection; using voluntary muscles to hold in an outward movement. Undoing retroflection involves reversing the sequence of events by finding out what’s being held in and supporting a completion of that outward movement.

Ultimately, the aim is to regain choice regarding the creative adjustment; in facial freezing, the stiffening of those voluntary muscles becomes rigidly automised. Massaging your face may feel quite silly, but it’s a great first step in gently easing any rigidity that has set in. And as that takes effect, you’ll find that the emotions being held back will start to come more strongly into your experience. The ridiculous gurning has the twofold effect of regaining control over stiffened voluntary muscles, and bringing that critical voice into awareness where it can be reasoned with.

The most interesting thing about this for me is just how revealing facial expression is. If you poker face me, then you’re actually sending quite a clear message: I need to hide something from you. That insight allows me to focus not on finding out what’s being hidden, but on exploring the need to hide.

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