Posts Tagged ‘process’

This post has been moved to my new website, and can be found here: Simple questions, complex therapy.

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This weekend, I set some time aside to complete my tax return. I have a patchy relationship with paperwork, especially paperwork mediated by online systems. And badly designed online systems the Government tells me I have to use by a certain date? Well I don’t like being told what to do either, so mandatory paperwork is on my list of Least Favourite Things Ever.

Anyway, I was moderately well behaved this year. I set aside time to do the tax return, and I sat down to do it. Sure, it took me an hour or so to log in because I had to hunt down my user ID. But once I’m logged in, my return is actually relatively simple to complete.

Except for: The Missing Document.

I work part-time for an employer, so I need to include information from my P60 on the tax return. But after much searching, I had to admit defeat: I’d lost it, and would have to request a replacement on Monday. Not the worst case scenario, but frustrating in that “if only I had done x” way unique to theoretically avoidable self-created obstacles.

That night, I had an immensely disgusting dream about shit. I took a massive shit that blocked the toilet. But my defecatory needs were so great that I had to finish shitting in a bucket. Then, having unblocked the toilet, I proceeded to empty the bucket of shit into the toilet. With a dessert spoon.

To be honest, just typing that out is making my gag reflex a bit twitchy. Ugh, much disgust.

Move to Sunday, and I’m starting to feel quite shitty. My son is down for an early afternoon nap, as is my wife. I’m wandering around with this shitty sensation, and I start to think about my dream. I mean, this one’s quite obvious, right? I need to clear up my shit. Except the shit in the dream is a metaphor for stuff I experience as shit in waking life.

In this case, that’s paperwork. After twenty months of being a dad, I can safely say I prefer changing shitty nappies to dealing with paperwork. By several orders of magnitude. (In fact, newborn babies’ shit smells like freshly baked biscuits for the first few weeks, so those nappy changing experiences were out and out enjoyable in their own right). Consequently, three things happen:

First, I need to dump a particularly large paperwork job (my tax return is the equivalent of taking one of those massive shits that isn’t even particularly enjoyable from a satisfaction point of view, just really messy and horrible).

Second, I block the toilet (paperwork is an ongoing process requiring background actions of filing useful stuff, and throwing out non-useful & expired stuff; suddenly needing to complete a bigger than usual piece of paperwork aggravates any incomplete background actions, blocking completion of the task in hand).

Third, I need to shit in buckets to complete my bowel voiding (to complete the tax return, I need to rely on ad hoc processes to find the information I need because I’ve blocked the easy route).

All of this adds up to a nice lesson to myself from myself on the importance of creating and maintaining a fit-for-purpose public sanitation system in the form of good paperwork practices. So I’m feeling shitty because I need to clear my shit. I sigh with resignation, and set about sorting out my accumulated paperwork blockage (a pile of metaphorical shit on my desk).

And no more than sixty seconds later, I’m holding the P60 I couldn’t find.

Dreams eh?

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

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Yesterday, I contributed a guest post to the Therapy Tales blog. “Time-capsule” is about one of the long-term benefits of therapy that isn’t measured by CORE and the like.

If you don’t already follow it, Therapy Tales is an ingenious exploration of therapy via the medium of cartooning. We are given a view of two sets of legs to set the scene of therapist facing client. This set up gives us the stable ground against which the figure of each strip’s exploration emerges.

When I’m processing a therapy session, I try to draw a simple cartoon depicting the session. This seems like an impossible task. Too much happens in 50 minutes; there’s too much information; there’s rarely a simple, easily defined focus; there is an abundance of nuance and possibilities. And yet, it is always possible to sum up a session with a drawing. How do I explain this? Well the clue is in the name: gestalt therapy. What I draw in my process notes is the gestalt of that session.

Cartooning has the potential to distil a large amount of information into a simple set of images. It is easier to hold onto these images than it is to hold onto the information from which they have emerged. However, once I meditate on those images, think about them, or play around with their arrangement, I recover huge amounts of information and discover new connections between them. I also find out a great deal about how I am relating to this particular person by attending to which events I give greater prominence to, and which events I sideline. The combination of operating non-verbally, and allowing an image to emerge spontaneously, engages my intuition and gives me something honest.

I enjoyed creating a cartoon about therapy. I think I will bring images into my blogging more.

~ ~ ~

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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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!

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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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