This report will conceptualise a hypothetical client, using the application of Gestalt methods whilst relating to Gestalt theory to analyse the client’s issues. C athy is a 45-year-old woman who’s been referred for counselling by her GP; she has been referred because of her 20 year bouts of depression and panic attacks. This assessment will analyse how Cathy makes meaning and contact with her world using the following three methods; support systems, modifications to contact, unfinished business/fixed gestalts.
The process of contact and withdrawal from contact defines the self (Lobb, and Litchenberg, 2005). The self is a phenomenological concept which exists alongside its environment, and neither can exist independently (Parlett, 1997). My understanding of Phenomenology is it refers to a person’s unique experiences, past and futures experiences are simultaneously parts of the field. However, past field experiences are not a concern as they do not present in the here and now. The environment changes on a moment by moment basis along with people within the field and their perceptions.
According to Clarkson (1989) “conceptually, the sequence of moments in the shift between figure and ground constitutes the gestalt formation and destruction cycle” (p6). Using this cycle will assist a counsellor in assessing disruptions to contact. On evaluation of the case study, it appears that Cathy’s figure/ presenting issue is her depression. In today’s society depression is a common symptom of psychological distress (Joyce, and Sills, 2010). Cathy mentions the loss of her mother; this historical ground and the re-experience of loss within her marriages may have formed a constant cycle of loss which has become a fixed gestalt.
This fixed gestalt may be a reason why Cathy and her environment are on different ends of a continuum. She appears to be very self-reliant. However, Cathy does not appear to use her environment to meet her needs. For example she states ‘she finds it difficult to discuss personal issues with her husband; also she takes herself off to bed and doesn’t attend her gym classes. ’ These types of disruptions to contact can be avoidance from pain or difficult feelings (Joyce, and Sills, 2010). The above disruptions are known as modifications to contact.
There are some possible interconnecting modifications, which appear to demonstrate how Cathy makes contact and withdrawal. Un-healthy retroflections are when a body’s energy is turned inwards towards itself, leading to bodily tensions like psychosomatic illnesses, impotency, depression or even self-harm (Joyce, and Sills, 2010, Mann, 2010). Cathy’s initial referal was connected to depression and panic attacks; this could be symptomatic of Cathy’s inability to express her feelings and insufficient environmental support.
Furthermore Cathy’s negative beliefs and fears of not being worthy, may well be related to her father’s negative interjects which Cathy seems to have taken in and kept as an unhealthy self-belief. When an individual’s experiences of their feelings belong outside their body this is an introjection (Mann, 2010). Cathy recalls her father saying “you will never amount to anything”. Unresolved childhood experiences or situations like this can lead to ‘unfinished business’ leading to dysfunction in adulthood (Clarkson, 1989). We could speculate that this belief of “never amounting” has left Cathy with current negative beliefs.
B. Essentially the assessment would allow a counsellor to understand the implications of Cathy’s problems and her suitability to Gestalt therapy. The counsellor’s aim would be to actively involve the client in raising awareness. This would enable her to move from a static historical pattern to a more flexible and responsive pattern (Joyce, and Sills, 2010) . The Gestalt model is a process orientated therapy which uses phenomenological enquiry, in relation to questioning what’s happening in the here and now for the client, empowering them to become aware of awareness (Yontef, 1993).
So how would the counsellor work with Cathy to develop awareness? Theoretically the counsellor would develop the client’s awareness using various strategies, one being the phenomenological method of enquiry; this is as much an attitude as a technique to stay with the here and now (Joyce, and Sills, 2010, Jacobs, 1989). This method would be used in order to investigate how Cathy perceives herself in her world, and it is important for the counsellor not to speculate or presume or reconfigure what’s going on for the client (Mann, 2010).
However, a part of this enquiry is not only noticing what emerges moment by moment but it is seeing the patterns and interruptions that underline the client’s issues (Joyce, and Sills, 2010). A possible emerging figure in the case study was Cathy’s insufficient use of her environmental support, i. e. difficulty talking to her husband. The Gestalt way of working would be to increase Cathy’s self-awareness; this may be done through suggesting an experiment which would give Cathy a safe environment to break her habitual way of contact.
The counsellor would ensure that Cathy was happy to try the experiment; an intervention example might be ‘I am wondering what it would be like to talk to your husband about a personal issue. Could you imagine him in this room with us now sitting in this chair? ” Subsequently, it would be incorrect to advise the client to go away and talk to her husband, as this would go against the paradoxical theory of change. This is a fundamental concept that connotes that the client needs to give up trying to change in order for change to happen (Beisser, 1970).
If the client is to develop a change in her awareness, the counsellor would need to enter into a dialogical relationship with the client . Creating a dialogical relationship requires the counsellor to accept a commitment to dialogue and work offering four key components; presence, confirmation, inclusion and willingness to communication. If a counsellor offers these components they are said to be offering ‘I-Thou’ (Jacobs, 1989, Joyce, and Sills, 2010, Woldt, and Toman, 2005). I –Thou is being fully present in the relationship without goals, meaning the counsellor has no desire to change a patient just meet them (Jacobs, 1989).
However, during this relationship it would be the counsellor’s duty to recognise any disruptions from the entire field, including psychological and physical factors. In the assessment unhealthy retroflections were a possible disruption; the counsellor may ask Cathy ‘is it possible that your depression is a way of expressing something you don’t know how to face? ’ This intervention may help Cathy to look at more fundamental issues, allowing Cathy to be more curious around her issues and will allow her to be reflective (Joyce, and Sills, 2010).
Another useful intervention which could be a possibility is for Cathy to keep a diary of her panic attacks with the intention of raising awareness of what’s happening in her zones of awareness, what feelings and emotions are coming from her inner zone, how her outer zone perceives the world and how her memories are cognitively processing within the middle zone (Joyce, and Sills, 2010). C. There is real controversy around the word diagnosis in Gestalt therapy, as it conflicts with the fundamental beliefs and principles of many Gestaltists (Clarkson, 1989 and Joyce, and Sills, 2010).
For example depression, this is a medical label which puts Cathy in a category and as a counsellor we would not want to objectify or depersonalise Cathy. Many Gestaltists believe that any label depersonalises and oppresses clients taking away the uniqueness of the client and his or her experiences (Clarkson, 1989, Joyce, and Sills, 2010 and Mann, 2010). I believe diagnosis is goal orientated fitting into that I-It concept, which could turn into I-Thou moment providing the assessment and dialogic relationship was effectively co-created.
However, whilst diagnosis goes against the fundamental principles of Gestalt, it is important to carry out initial and on-going assessments. Joyce and Sills (2010) state “what is more, it is professionally and ethically necessary to do so” (p53). Due to Cathy’s referral being for depression it would be unprofessional and un-ethical not to complete a risk assessment as Cathy could be at risk, as the risk of suicide in depressed clients is great (Joyce, and Sills, 2010). D. Theoretically the Gestalt and person centred models have many similarities yet notable differences.
Both models are process orientated; however, Gestalt is more directive and led by phenomenological enquiry using experimentation (Joyce, and Sills, 2010), whereas person centred is not about techniques it is a way of being using reflective processes. Whilst discussing hypothetical interventions an experiment was mentioned using the empty chair technique; I feel this shows Gestalt therapy is distinct because it moves active awareness. However, with the person centred approach the client will have been reflectively engaged.
Taking this into consideration it appears Gestalt therapy shows effective releases for repressed emotional stress, which Cathy seems to be presenting with. After looking at the similarities and differences of these two models, I have come to the conclusion that the benefits of both models would be suitable for Cathy based on the limited information. The Gestalt techniques and methods seem to hold adequate weight in terms of direction and effectiveness; likewise I can see the benefits of the reflective processes and the Person Centre approach