Transcript Existential/Gestalt

Existential
Psychotherapies
EXISTENTIAL APPROACHES
 Way of thinking about humans and about life that
may be applied to other psychotherapy approaches
 Closely linked to European Existential Philosophy:
 Dilemmas of contemporary life (1940-50s)
 isolation, alienation and meaninglessness
 Importance of subjectivity – we create our values, our
lives, ourselves
 Truth depends on the existing person, in a given
situation and in a given time
 Freedom to be ourselves implies responsibility
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European Existential Philosophers
 Kierkergard
 angst - dread and anxiety related to uncertainty in living
 Nietzsche
 Values are within the individual
 Sartre
 Freedom to be what we choose and related responsibility
 Simon de Beauvoir The Second Sex
 Buber
 Stressed the I/Thou Relationship – less individualistic
 Biswanger
 existential analyst, emphasized subjective and spiritual
dimensions
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Existential Psychology
 Victor Frankle
 Logotherapy Man in Search for Meaning
 Nietzsche “He who has a why to live for, can bear
with almost any how.”
 Rollo May
 Co-editor : Existence: A New Dimension in
Psychiatry and Psychology (1958) introduced
existential psychology to the US.
 Irving Yalom
 Existential Psychotherapy
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Basic Dimensions of the Human
Condition
 Capacity for self-awareness
 Freedom and responsibility
 Creating one’s identity and meaningful
relationships with others
 Search for meaning, purposes, values
and goals
 Anxiety as a condition for living
 Awareness of death and non-being
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Theory of Personality
 Dynamic Model
Forces in conflict
 need to survive and assert one’s being vs.
conscious and unconscious fears related to:
 Givens of Existence or Ultimate Concerns
 Death
Freedom
 Isolation
Meaninglessness
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Conflict/Mental Health
 Awareness of Ult. Concerns
>>>Anxiety >>> Def. Mechanisms
 Ways to deal with the anxiety
 Provide safety, restrict growth
 Mental Health
 Ability to cope with normal anxiety
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Anxiety
 NORMAL ANXIETY
 Proportionate to the situation
 Does not require repression
 Can be used creatively
 NEUROTIC ANXIETY
 Disproportionate to the situation
 Tends to be repressed
 Paralyzes the individual
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Guilt
 Normal
Ethical aspects of behavior
 Neurotic
Fantasized transgressions
toward others, or failure to live
up to one’s capacities
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Objective of Therapy
 Explore anxiety related to the ultimate
concerns, concious/unconscious
 Identify mechanisms of defense (symptoms)
clients use to deal with existential anxiety
 Move clients to confront the fear and the
pain associated with the ultimate concerns
 Help clients develop adaptive ways of dealing
with existential anxiety
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Freedom vs. Responsibility
 We are ultimately responsible for who we
are, what we believe in, and how we
behave
 We must make authentic choices rather
than follow what has been given to us
 Anxiety is generated by our fear of not
knowing or of making mistakes
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Responsibility: Defenses
 Displace it
others/circumstances
 Deny responsibility
e.g. victim role
 Avoid responsibility
e.g. symptoms
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Process of Making Decisions
WISHING >>>> WILLING >>>> ACTION
Symptoms
 Impulsive Behavior
 Non-discrimination among wishes
 Compulsive Behavior
 Driven by ego-alien demands
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Freedom:Therapy
 Help client recognize and accept
responsibility for making choices
 Confront responsibility avoidance
(won’t vs. can’t)
 Encourage clients to connect with their
feelings
 Explore how client contributes to
problem situation
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Isolation
 Awareness of our intrinsic isolation vs.
desire to be part of something larger
 Interpersonal
social skills, intimacy
 Intra-personal connected with self
 Existential
Unavoidable
 Defense:
 Fusion: soften our ego boundaries and
become part of another individual, group,
or cause
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Isolation: Therapy
 Help clients confront their fear of aloneness
 Personal growth entails a degree of isolation
 To create authentic relationships with others we
must have confronted and accepted our
ultimate isolation
 Within the real relationship between client and
therapist, client may learn limits and rewards
of intimacy
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Meaninglessness
 We naturally search for meaning, but we
live in a world where there are no intrinsic
meanings
 Need to construct a personal sense of meaning
 “Wishing” Source of meaning require access to
affective experience
 Meaning is usually found when we look beyond
ourselves and meeting our material needs.
 A sense of meaning is related to our values that
tell us why we live and how to live
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Meaninglessness: Therapy
 May not be an issue for all clients
 Personal growth
 Boundary situations
 Depression
 Help clients connect with their affective
selves, to discover inner sources of motivation
and meaning
 Help clients get engaged in life activities
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Boundary situation
 Experience or event that propels the person to
face an existential situation related to any of
the ultimate concerns:




terminal illness
death of a loved one
life crisis
life change
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Death
 Fear of self-destruction – primary source of
anxiety
 Defenses against death awareness – denial,
reaction formation
 Awareness of death gives meaning to our
life
 enhances the importance of the present
moment
 leads us to live more fully
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Defense Mechanisms
Awareness of Ult. Concerns >>>Anxiety
>>> Def. Mechanisms
Drive >>> Anxiety >>> Def. Mechanism
 Defense mechanisms provide some temporary
relief, but they restrict growth
 Existentialists ascribe to the defense
mechanisms that were proposed by Freud
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Psychotherapy : Goals
 Main goal is to help clients
 increase awareness about themselves and
how they are living
 confront their anxieties and fears
 re-define themselves and their world in ways
that lead to a more authentic life
 Main vehicle of therapy is an authentic,
real relationship with therapist
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Psychotherapy: Relationship 1/2
 Therapy is a journey taken by therapist and
client
 The person-to-person relationship is key
 Therapist stays in contact with their own
phenomenological world
 Therapist must distinguish between transference
and the actual, real relationship (they co-exist)
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Psychotherapy: Relationship
 The core of the therapeutic relationship
 Respect and faith in the clients’ potential to cope
 Sharing reactions with genuine concern and
empathy
 Focus on the here-and-now experience in the
therapeutic relationship
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Psychotherapy: Techniques
 Paradoxical intention
 prescribing the symptom: help clients gain more
control of their behavior, get “unstuck”
 Situational reconstruction
 think of three ways in which a situation could be
better and three ways in which it could be worse to help people move on from the place they are
stuck
 Compensatory self improvement
 work on areas that you have control when you are
in a situation you don't control
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Contributions
 Provides new dimensions to the
understanding of death, anxiety, guilt,
loneliness, and alienation
 Emphasizes the person's freedom and
responsibility in designing their own
lives
 Importance placed on the human quality
of the therapeutic relationship
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Contributions
 Philosophical orientation applicable
regardless of counselor’s theoretical
orientation
 Particularly useful to understand issues
presented by clients who may be
confronting existential crises
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Limitations
 Lacks a systematic statement about
principles and practices of
psychotherapy
 Does not lend itself to empirical
research
 Concepts are abstract and difficult to
apply in practice
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Gestalt
 Existential & Phenomenological – it is
grounded in the client’s “here and now”
 Initial goal is for clients to gain awareness of
what they are experiencing and doing now
 Promotes direct experiencing rather than the
abstractness of talking about situations
 Rather than talk about a childhood trauma the client
is encouraged to become the hurt child
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Frederick Perls 1893-1970
 Born in Germany,
 Psychiatrist and psychoanalyst
 Emigrated to U.S. in 1946 and broke form
psychoanalytic tradition
 Controversial and charismatic figure
 Gestalt therapy became a kind of cult
 Collaborated with his wife (Laura Perls 19051990) in delivering workshops and writing
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The Now
 Our “power is in the present”
 Nothing exists except the “now”
 The past is gone and the future has not yet arrived
 The power of the present is lost if :
 We focus on past mistakes or engage in endless
resolutions and plans for the future
 Therapist focuses more on the process of therapy
than on the content
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Unfinished Business
 Unexpressed feelings such as anger,
resentment, and fear that are:
 Threatening
 Not fully experienced in awareness
 Interfere with effective contact with oneself and
with others
 Result:
 Preoccupation, compulsive behavior, wariness
oppressive energy and self-defeating behavior
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Contact and Resistance to Contact
 CONTACT
 To interact with environment w/o losing one’s
individuality
 Requires awareness, energy and ability to express
oneself
 RESISTANCE TO CONTACT
 Defenses that prevent experiencing the present fully
 There are five major channels of resistance to attempt
to control the environment rather than allowing real
contact
 Typically are out of awareness; may contribute to
dysfunctional behavior
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Defenses
Resistance to Contact
Introjection
Uncritical acceptance of others’ beliefs and
standards w/o making them our own.
• Lack of clear sense of self
Projection
Retroflection
To disown certain aspects of ourselves by
ascribing them to the environment
• Victim stance ; powerlessness to initiate
change
To turn back to ourselves something we would
like to do (or have done) to someone else
• Self-injury vs. fear of directing aggression
outwardly
• Depression; psychosomatic symptoms
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Defenses
Resistance to Contact
Deflection
To avoid real contact and awareness by being
vague and indirect.
• Humor, abstract generalizations, ignoring
Confluence
To loose the sense of the boundary between
self and environment (others).
• Go with the flow, enmeshment,
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Goal Gestalt Therapy
 Gain awareness
 Know the environment
 Know oneself
 Learn about dominant ways of avoiding contact
 What does the resistance does for the client
 What it protects them from
 What it keeps them from experiencing
 Accept oneself and responsibility for self
 Allow oneself to make contact
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Therapist Role
 Provide an authentic relationship
 Focus on process versus content
 Devise experiments to increase client’s selfawareness
 Coaches clients to arrive at their own
interpretations/does not provide them
 Confrontation
 Intervention to help clients become aware of
discrepancies between verbal and nonverbal
expressions, feelings and actions, and/or thoughts and
feelings.
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Gestalt Experiments
 Allow clients to express themselves
behaviorally
 Lead to fresh emotional experiences and new
insights
 Facilitate experiencing in the moment, rather
than talking about….
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Gestalt Experiments
 Internal Dialogue
 Making the Rounds
 Reversal Exercise
 The Rehearsal Exercise
 Exaggerating Exercise
 Staying with the Feeling
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Contributions and Limitations
• Creative use of active experiments and
activities to help clients achieve
experiential learning
• Confrontational style that deemphasizes
cognitive factors
• Experiments can be used by therapist in a
manipulative way
• Highly active and directive stance of
therapist may lead to abuse of power
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