Archive for November, 2011

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.

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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.

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