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Archive for December, 2012

I’m reading Jean-Marie Robine‘s “On the Occasion of an Other” at the moment, and enjoying immensely getting to grips with his attempt to develop gestalt in an explicitly post-modern direction.

A by-product of chewing over his thoughts has led to something clicking into place for me. I have made the shocking realisation that…

… no one really understands what gestalt is!

*shocked face*

I already knew this of course, in that intellectual way of knowing that such and such is A Thing. After all, every ‘how to do gestalt therapy’ book in existence dedicates a portion of text to emphasising just how hard it is to explain what gestalt therapy is. It is a given for me that gestalt therapy is both a radically different approach to doing therapy, and one that is hard to explain.

And therein lies the problem; it is a given for me that this is the case. However, unlike therapists with an integrative training who might touch briefly on gestalt, my training is pure gestalt. That’s years of gestalt training; a developmental journey in which my peers all grew their own gestalt styles; gestalt personal therapy; gestalt supervision; ALL THE GESTALT BOOKS! In short, my professional identity as a psychotherapist is constructed entirely out of gestalt.

Consequently, when I meet people from the dark and hazy places that lie beyond the borders of Gestalt World, I am frequently shocked when their knowledge of gestalt is based on Gestalt Therapy Verbatim. Now, I’m not a fan of the Perls-bashing many gestaltists feel the need to engage in, but Gestalt Therapy Verbatim is essentially Fritz Perls at the height of his days as a popular figure in American counter-culture. Gestalt Therapy Verbatim could easily be re-named “Fritz Perls Kicks Ass, Saves World”. Which isn’t to say it’s a bad book or bad gestalt, it’s just not particularly representative of the possibilities.

Essentially, to pick up on my earlier metaphor of the forest in the distance, I’ve been in the forest so long, I’ve forgotten that the city doesn’t have trees. Or something.

One of Robine’s missions in On Occasion of an Other seems to be a rehabilitation of gestalt’s field theory that places gestalt therapy in a post-modern context. This is your basic metaphorical Copernican Revolution, and it goes like this:

Gestalt therapy involves a paradigm shift in which human experience is no longer seen as the product of a concrete individual, but as an expression of a situation.

Those are my words rather than Robine’s, so may not be an accurate account of what Robine is actually trying to do. However, they are an accurate account of what I have been intuiting about gestalt in an annoyingly hand-wavy non-verbal kind of way. I am deeply grateful to Robine for providing the occasion by which my thoughts can be clarified.

This is a Copernican Revolution in a very real sense. The historical Copernican Revolution shifted the centre of the heavens from the Earth to the Sun. Gestalt Therapy’s Copernican Revolution shifted the centre of human experience from the individual to the organism/environment field.

I experience Robine as attempting to complete this shift by switching focus from the organism/environment field (an incredibly opaque term that is difficult to write about in an accessibly meaningful way) to the situation. In fact, ‘situation’ might be a better way of saying ‘organism/environment field’ simply because the very idea of a situation demands that I consider a thing and the context by which it is recognisable as a thing.

The shift is subtle but the consequences are profound. Consider a meat and potatoes clinical issue like social anxiety. In the individualist paradigm, there is basically a fault in the individual that must be corrected. Even person centred therapy with its actualising principle and core conditions presupposes that the appropriate focus for work is internal to the individual. The shift here is simply in attitude; instead of correcting a fault in an individual, therapy is about giving an individual the support they need to grow.

In the situational paradigm (I think Robine would say post-modern here, whereas Gordon Wheeler would say constructivist), what we call social anxiety is an expression of the situation. It’s not even necessarily that we identify historical experiences that have caused someone to experience social anxiety in certain contexts. Rather, the specific symptamology that gets packaged conceptually as “social anxiety” is simply a part of the situation.

Example: have you ever felt nervous on someone else’s behalf? I sometimes experience stage fright in theatres as a member of the audience. One possible situational perspective would be to completely destructure all the possible experiences of the situation (this is why Robine calls for gestalt to enter a post-modern way; post-modernism involves a destructuring of familiar forms followed by a restructuring of new forms). Let’s take the anxiety an actor feels about performing and, in order to support that actor in being able to function on stage, find members of the audience to express it instead.

That is to say, someone has to feel the anxiety, or the situation breaks down. Maybe theatres could pay people who are sensitive to (effective expressors of?) acute anxiety to sit in the audience so that the actors can chill the hell out. That sounds odd, but then again no stand up comedian, however good we consider them to be (individualist paradigm perspective), will crash and burn if the audience stonewalls them. Comedian and audience are enmeshed in a situation in which The Funny is co-created; no audience will laugh without the comedian, but no comedian is funny without an audience. “Comedian” and “audience” are situational perspectives.

“Therapist” and “client” are also situational perspectives. I experience the therapeutic situation very differently depending on whether I am therapist or client.

What really differentiates gestalt from other therapies isn’t methodology but perspective. Gestalt is unique in considering psychological concepts such as self, personality, id, and ego as situational processes, not fixed structures.

Ego, for example, is the process of identification with and alienation from available possibilities. Not a timeless “I am this, not that” but a situated “I am this now, I am not that now” that is dynamic and in constant flux. That is, ego is the means by which a situation differentiates itself into perspectives. Hence, I have different experiences depending on the situation of which I am a part; it is the situation that organises experience.

I expect I will have lots more to write in this direction. For now, I am bubbling with excitement as I renew my sense of gestalt’s radical approach.

~ ~ ~

My name is Simon Stafford-Townsend. I am a gestalt psychotherapist in private practice in Bristol and Cardiff. My private practice website is Silver Cat Psychotherapy.

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A recent post in The New York Times has provoked a couple of responses from therapists on my blog list (which, incidentally, I stole wholesale from Shrink Things, thanks WG!). This is an area of practice I have been focusing on lately, so I’m offering some thoughts.

The essence of Lori Gottlieb’s What Brand is Your Therapist?” is that psychotherapy is difficult to sell; therapists are having a tough time finding clients; and the need to survive in private practice necessitates that therapists attend to their branding.

Steven Reidbord takes this with a pinch of salt; therapists need to attend to branding but within limits. Meanwhile, The Irreverent Psychologist is clear that this is all “very tired advice”. For Shirah Vollmer, on the other hand, “this is a stimulating article which poses the question of supply and demand. Is there a demand for insight-oriented psychotherapy, or is the demand for a relatively quick-fix to a very specific problem?”

This is at the forefront of my awareness at the moment because I have been getting more serious about marketing my private practice. My attitude is that I’m a good therapist, there are people out there who will benefit from working with me, and marketing is the means by which I let those people know I exist.

So a couple of months ago, I attended a workshop on marketing for therapists. One of the interesting exercises was looking at a variety of images of real world markets and products on sale. We then shared our responses to the different scenes, and reflected on what that could teach us about marketing our practices.

One of the images was a crowded street market. Either side of the street was a massive wall of high rise buildings; the market colourful, awash with people, myriad market stalls all pretty much blending into each other and the crowd.

I’ll admit, I found the scene exhausting just to look at! But my focus quickly shifted to something else. When I was asked what stood out for me, I pointed out that far off in the distance was what looked like a forest, and that my attention had settled there. The facilitator did a double take; she hadn’t noticed the forest in the distance before.

I have chewed over this episode for a while, and it’s taken me a while to settle on what it means for me in relation to marketing my practice. What I’ve arrived at is this:

There is more to life than the market.

What is a market? Surface level answer: a market is a place where people buy and sell things. But a deeper answer is also possible, because the market symbolises something very powerful: human beings getting their needs met through mutually beneficial exchange.

The basic premise of a market is that someone has something I want, and will give it to me in exchange for something else. Every want is driven by a need, and so the essence of every market place is two people getting their needs met.

The forest in the distance is a reminder that the activity that grows out of these needs (which, incidentally, are never ending because the meeting of one need simply makes room for awareness of a new need!), can be so time consuming that it’s easy to forget they are actually a support for something: just being. And psychotherapy is one path by which the forest in the distance can be discovered.

Psychotherapy is not difficult to market, even if it is difficult to sell. I see two reasons why psychotherapy is difficult to sell:

1) Psychotherapy isn’t a product, it’s a discipline. Consequently, psychotherapy isn’t what gets bought and sold; it is one specific psychotherapist’s time that gets bought and sold. As The Irreverent Psychologist points out, Gottlieb is a recent graduate, so “of course she didn’t have a thriving private practice. She is just starting out”.

I don’t sell lumps of psychotherapy, I sell 50 minutes of my time. For a lot of money. There are lots of reasons why I and the people who know me think my time is worth every penny. But if someone has just clicked through to my site from my Google Ad, all they have is a website to go on. Maybe there are future clients reading this blog or following me on twitter to get an idea of me. But that’s really an extension of my point: I am selling my time, and it takes time and effort to build a reputation.

So, re-frame: “psychotherapy is difficult to sell” because each psychotherapist is selling their time, not a tangible thing.

2) Two of the most powerful forces in psychotherapy are avoidance and resistance. No one undertakes a difficult and often painful journey into their deepest darkest recesses for a lark. This creates a paradox: psychotherapy is a healing journey in which everyone wants the healing, but no one wants the journey.

I’m asked if I have a magic wand so often by clients that I’m considering buying one just so I can say yes and use it for a projection experiment. Psychotherapy simply is hard work. So you had a difficult childhood, feel like you’ve been depressed pretty much since age 7, regret missing out on formative experiences and wonder what could have been? Six sessions will not heal this. A ten point self-help guide will not heal this. There’s no guarantee even that years of psychotherapy will heal this.

So, reality check: “psychotherapy is difficult to sell” because it is a healing journey that is often long, difficult, and painful.

To return to the forest in the distance, I think the core message that I see in psychotherapy is something people need now more than ever: there is more to life than the market. This is an especially poignant message in an age of global economic collapse and dramatically widening gap between rich and poor.

The forest in the distance represents the endless adventure and mystery of being human. The problems that bring people into therapy are surface level manifestations of the deep, existential issue of being a living mystery endlessly exploring itself.

Developing niche, issue-oriented stalls in the therapeutic market place is one way of doing things, and is suited best to people who enjoy being in the bustling market. It is also exactly what a large number of people want: something that attends solely to the issue for which they are seeking support. But let’s be clear; this is counselling, not psychotherapy.

The marketing issue facing psychotherapy is a lack of effective communication between psychotherapy as a profession and the society in which the profession exists.

Our professional context is important. Big Pharma has made billions of dollars convincing people that being human is a treatable chemical imbalance in the brain. The first port of call for many people in need of therapy is their GP, who then diverts their patients into an NHS care pathway geared towards medication, self-help, and short-term CBT. And that’s before considering the niche, issue-oriented counsellors using increasingly sophisticated methods to better target their marketing to specific groups.

To extend my analogy a bit, the market is big, there are lots of stall holders, and there are lots of people trying to find what they need.

But how many people are pointing out the forest in the distance?

~ ~ ~

My name is Simon Stafford-Townsend. I am a gestalt psychotherapist in private practice in Bristol and Cardiff. My private practice website is Silver Cat Psychotherapy.

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Today’s blog post is brought to you by Freddy Weaver. By way of context, Freddy and I are involved in forming an IPN Group (future blog post on IPN/therapist accreditation pending) so I’m finding this an interesting way for me to see more of his professional influences.

Last week Focus Counselling hosted Brian Thorne’s “last public speaking event on the circuit” at St. Michael’s Church on Broad Street, Bath.

I was excited. I had “discovered” Brian Thorne, the much-admired torch-holder of the Person-centred tradition in the UK, two years ago when my new supervisor pointed me towards his work. The clarity, courage and heart in his writing spoke to me of an approach to counselling that I had hitherto been unable to find, yet felt called to employ. I was grappling with the division between my experience of working in fairly directive environments (addiction rehabilitation centres) and my yearning to bring a softer, more permissive, yet more authentic aspect to the therapeutic encounter. Here, it seemed, was a man who was willing to throw caution – and perhaps the security of specific techniques or targets – to the wind: to uncompromisingly meet his clients’ relational needs. Using Carl Rogers’ triumvirate of core conditions as his watchword he shone light upon a legitimate way forwards in my ideological impasse! I admired, too, his willingness to fly in the face of convention, take risks and challenge a discipline in which it is easy to allow caution to overwhelm creative clinical integrity.

Thorne began with the impact Rogers has had on psychotherapy. He spoke with conviction about the Rogerian approach in which “what mattered was the kind of relationship he offered his clients – nothing less, nothing more.” He touched on the actualizing tendency – the underpinning assumption of his approach -, which espouses that, if met with the right conditions, people will grow, develop and realize their full potential. He praised Rogers’ refusal to assert power within the therapeutic relationship, and noted that this commitment followed through into his work as an international peacemaker towards the end of his life.

He spoke of Rogers as “The Quiet Revolutionary”. In many ways Rogers’ impact on western society is so great that it is invisible: his ideas about the value of listening, of the transformative power of self-expression in safe conditions has become almost ubiquitous. Our society’s narcissism has, of course, taken this individualizing impulse to an extreme in which many foster a self-centredness, expressed by the need to share intimate details to all and sundry in the form of reality television, social media etc. (The irony of my posting this critique on a blog is not lost on me!). However, the cultural shift from a position of excessive emotional containment to one of increasingly widespread emotional tolerance remains a sign of progress towards a more balanced way of being.

Thorne touched on the core conditions of Unconditional Positive Regard (acceptance), Empathy (understanding) and Congruence (authenticity), which have been so influential in the development of counselling. I would have loved to hear more of his thinking around these admittedly widely discussed attitudes. But Thorne was on polemic form and seemed more interested to address some of the more contentious and portentous issues on his mind!

Thorne chose to focus on Rogers’ final book A Way of Being (1980), which came to acknowledge the transcendent, the mysterious, and the spiritual in the therapeutic encounter. In the world of psychology this unquantifiable language, let alone concept, was not welcome. Indeed, Thorne was saying that many within the person-centred tradition had actively avoided and ignored the implications of Rogers’ later writings, preferring to focus on the more accessible aspects of his early philosophy. Thorne seemed to be admirably supporting a more transparent acknowledgement of these elements within psychotherapy, and was at pains to communicate the failure of contemporary psychotherapy and society to integrate spirituality into its value systems. He did not address the issue of how this might be embodied on a practical level within counselling, or how to prevent therapists imposing, however subtly, their own belief systems on clients.

Thorne spoke as if a lone voice in the wilderness. But is he really so unusual in championing the transparency of the spiritual in therapy? Did not Jung turn to alchemy, mystery schools and eastern esoterica in his penetrating search for meaning? What about Transpersonal Psychotherapy – a whole psychological tradition that acknowledges the presence and importance of the soul life? More recently, with the fruitful incorporation of mindfulness and eastern awareness traditions into mainstream psychology, there seems to be increasing tolerance for the dogma-free techniques and tools of contemplative religion in therapeutic systems. Moreover, there are numerous openly Buddhist psychotherapists in practice and broadly held esteem. To my mind the position that Thorne was taking was aimed more at policy-makers than practicing therapists.

It was Thorne’s contention that the current climate of service provision, with its focus on outcomes and interventions, rather than the quality of human relationship, sanitizes and stultifies therapy. The current system encourages us to become “psychological technicians that tinker around with the psychological mechanisms of the human mind”. He felt that this represents more than the simple mistake of overemphasizing form over substance. For him it is evidence of the field of psychotherapy becoming infected by the shadow aspects of our society – namely an obsession with achievement over experience, productivity over provision, and consumption over everything. The increasingly litigious environment, he feels, is contributing to the crushing of therapeutic creativity – and thus we therapists are losing the ability to model a creative, spirited self to our clients for fear of judgement and condemnation. His concern was communicated with an oppressive solemnity and extended out from the therapeutic world to the challenges facing humanity in general, from continued human atrocities to global warming.

Many of his concerns I emphatically share. I’d consider myself a poor therapist indeed if my observations of societal ills did not extend into the restrictions and challenges of the context in which our clients are living. I was somewhat baffled, then, by his focus on these woes because my very being a therapist is born from a keen awareness of these massive challenges, and the instinctive desire to therefore facilitate meaningful individual and collective change. I admire his willingness to take on denial and break our seeming indifference towards the challenges we face. But in this case he was preaching to the converted, and rather than offering constructive insight, dwelt on hopelessness, whereas I see progress in many areas of human development.

He did observe that, while support for the traditional faiths of the world is dwindling in this country, the contemplative orders are flourishing and that an authentic individual search for spiritual connection is flowering. He also noted that the quality of relationship, although not yet at the centre of psychological policy in the UK, is becoming increasingly recognized. But he didn’t seem to join the dots of these significant shifts towards a brighter future. To me the growth in partisan spirituality is evidence of a cultural development that seems to embody the person-centred ethos of allowing organic, rather than imposed, evolution to take hold.

During question and answer time at the end he softened. Having sounded the clarion call of doom he was perhaps ready to acknowledge hope! Interesting questions were raised which prompted the observation that in order for things to change a crisis often needs to be reached – a scenario I’m sure many of us are familiar with in our personal and professional lives.

Near the beginning of the talk Thorne threw down the person-centred gauntlet: “I am challenged to trust my client as a person designed for wholeness and possessed of the inner resources to achieve wholeness.” I am endeavouring to extend this trust to humanity as a whole, as well as my clients. My challenge to Brian Thorne is to do the same.

As I observe clients grow I see the changes they make radiate out across the constellations of their relationships, like ripples in a pond. So, as each of us progresses along our own growth towards our potential I believe we make a microscopic, yet meaningful, contribution to the evolution of the systems to which we belong. For anyone who feels discouraged by the task ahead, be it in response to a personal or the global situation, I offer you these illuminatingly paradoxical words from Gandhi, “Whatever you do will be insignificant, but it is very important that you do it.”

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