Richard Dennison

gestalt therapist | group therapist

07753 827745
                 01395 487397

The Practice Rooms, 15-16 Castle St EX4 3PT

The Practice Rooms, 26 Upper Borough Walls BA1 1RH

Group Work with a Gestalt Perspective

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We are usually born into a family unit. This will be our very first experience of a group. This first experience will be very informative for the child and later the adult. What we learn in this environment can remain for many years to come.

The therapy group may well be a reminder of this very first experience. As we enter into a therapy group, very often the first thought will be “will I be accepted?”. In our very first family, was I accepted? It is interesting to look at the process of entering a therapy group and the feelings that are around at this time. It is usually at time of heightened arousal and excitement. New people will be met and experienced… how will they perceive me? How will I get along with them? Indeed how will I deal with the heightened excitement? Can I support myself or will the anxiety be too much?

The therapy group will provide potential for each member to look at how we are in this environment. Does it remind us of things in the past and how can the member deal with the satisfaction or unease of being here and now? This is the starting point of acceptance of where we are now. A crucial point. With the new awareness and acceptance, the opportunity arises for individuals to change the way they react to others and situations within the group. The group can be the starting point to change behaviour. Members can engage in experiments. Here new ways of behaviour can be attempted and subsequently individuals can learn different ways of interacting, which then can become gradually more comfortable to use and then integrated.

At this point there is the opportunity to take new awareness into our lives. With self-support and support of others there can be a new sense of going into the world with a new view on life, and however difficult, a new optimism.

 

Relationship issues and couple therapy in Gestalt

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Couples and relationship issues are increasingly prominent in my private practice. How are these issues addressed within therapy? The presence of a third party, the therapist, changes the dynamic of a couple. There is in the session a sense of a wish to change things and try something different, this alone is often what brings a couple into therapy. It is this dynamic that enables the therapist to bring to awareness aspects that together a couple may not be able to explore.

Issues such as trust are often to the fore of relationship issues. When trust has been betrayed, can it be re-established and how do we go about this? Trust is fundamental to human existence. We are constantly reminded about trusting this or trusting a fellow human. If we do not have trust then what happens to that relationship and to the individual who lacks the feeling of trust? Is a relationship without trust worthwhile? The relationship can then certainly be at a disadvantage and a distance is created.

Feelings of being able to trust come about when we feel confident and have self-esteem. It is then that it is possible to feel that if trust is betrayed by the other, it is not our fault. There is a deserving quality in all of us that can expect and respect trust from another. It is in these conditions that a relationship can flourish and grow. A couple who can relax together enjoy each other’s company and trust each other.

Can a relationship be repaired after a break in trust? Much will depend on the nature of the individuals involved. If the self-esteem and confidence has taken a blow then maybe this can be repaired over time and by looking at what exactly has been damaged. This can be achieved by a close look at the process of self-esteem and the needs that are present… however, there is much courage that is needed and an ability to let those feelings of trust rise once more. Feelings of guilt may also be around from either party. Inquiry into how these feelings arise and the influence they have in the relationship now need to be examined.

The ability to complete the healing that exists after wounding takes time, courage and commitment. It is likely that the relationship will change, to be relaxed within a relationship allows each individual to grow, become closer and intimate. The session in gestalt couples therapy focusses on the contact in the relationship. Blame and fault are not to the forefront, the ability to move forward and solve difficulties in the relationship is the primary process.

Support in Therapy.

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It is often surprising how imperative issues such as support, are not addressed within therapy. This could well be one of the first considerations that a therapist would take when seeing a new client in the initial session. Does he/she feel supported in the therapy session? What aspects of support does this individual receive outside the session?

Support is everything that exists, that helps a person integrate experience and move toward change. Often individuals who come to therapy lack support for the everyday contact; contact that is both needed and desirable for the situation in which they find themselves. These are the conditions that favour certain processes of relating. Lack of this essential support is experienced as anxiety. It follows that it is not a question of what support is needed, but of what support is available.

Support available will be different for each individual. When sufficient support is present, the individual is in contact and can feel pain. When insufficient support is present, the subject can somehow be absent. Therefore, there will be a need to feel present in the body; follow the breath and feel connected. For others, it may be a need for a network of friendships, people to be with and with whom connections are made. For others, it could well be both and more. This may sound simple, but for some this support does not exist. Remember, support is everything that exists, that helps a person integrate experience and move toward change.

Gestalt therapists will cultivate the growth of support by the application of self to the situation and to the client. A large part of this, is the aspect of accepting the client at the place they are in, rather than to push in a direction that maybe deemed preferable. This includes blocks or avoidance that have previously been supportive.

When a client feels supported, maybe at first only in the session, then deeper work can commence. Other aspects of support can be introduced widening the field, integrating new awareness and changing patterns. All carried out with the realisation that it is essential that all support networks remain in place, those for the client as well as for the therapist.

 

Acceptance and Opening in Therapy

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When an individual comes into therapy, in the majority of cases they are seeking to change something in their lives. It may be a question of experiencing feelings of self blame and worthlessness or questions of how can I get things right or why does everything always go wrong for me.

Well, sometimes it is just good to sit and to appreciate that someone is listening to me without interruption, without putting me down, without criticism, or without making judgements about me or my behaviour. How refreshing this feels. Can this be the start of the process toward feeling like a worthwhile human being once more?

On so many occasions I have found that in the first instance all that people need is some form of validation in the sense that they are really not as bad a person as they have very often been lead to believe.

Take a look at the good points in life, the good aspects of yourself and the good things that you have done or achieved. Have these moments been lost or forgotten? Dwell on these for a moment; feel them in the body and the subsequent change in you that these feelings create.

Take a moment every day, maybe only five minutes. Sit down and accept yourself for who you are, yourself; as a wonderful human being and still fallible and vulnerable. What does this feel like? Feel this acceptance also in the body and the ensuing strength. Can you feel compassion that may follow for yourself and others?

Groups Therapy

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Groups are an exciting, difficult and powerful vehicle for personal growth. In a group you have the opportunity to learn from your interactions with other group members and the facilitator about your interpersonal style, including your ways of interrupting and distorting contact. Groups can provide an immediate opportunity to experiment and to risk new ways of being with others. Often the group will provide a sense of closeness and belonging, an opportunity to connect and to grow. the assumption being that you will transfer what you learn from the group to the rest of your life. 

Group process in the here and now is primary for investigation…attention to feelings within the group and toward other members. Awareness of opportunities for and fear of innovative behaviour. Opportunities for and expectation of each member participating emotionally, cognitively and behaviourally, although each member is free to work at their own pace.

Thoughts on techniques, feelings and emotions in therapy

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I think now and again about how many technique based therapies are around. I was subjected to a Solution Focused Approach meeting a few days ago and left feeling rather sad. It seemed that this approach divorces feelings from behavior and requires us to look for solutions (behavior) within the dictates of this approach. 

For Gestalt and myself, feelings or emotions are very much what it means to be human and if these emotions are suppressed then this action will lead to problems down the line. Are we to become more and more like machines?

Shame in Counselling and Therapy

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Shame so disturbs the functioning of the self to the extent that there is the wish to no longer exist. On the other hand shame can subtly intrude on many events in the lives of a many people. In my view few people have never experienced shame and the issue is often very poorly or never dealt with in the therapy situations.

Mild shame arises when feelings of deep embarrassment occur, when we feel reddening of the face, reluctance to maintain eye contact and wish to withdraw. This can happen within work or social settings or indeed almost anywhere. Acute shame is experienced as not wishing to exist, hiding away or wanting the ground to swallow up the individual in order to avoid these feelings. The feeling of being exposed opens the self to external and internal scrutiny that at this time has to be avoided. This self consciousness becomes paralyzing and silencing. Lee (1994) has outlined a list of shame variants: shyness, embarrassment, chagrin, humiliation, low self-esteem, feeling ridiculous, sheepishness, discomfort, disconcertedness, abasement, disgrace, ignominy, dishonour, mortification, degradation, self consciousness, discouragement, guilt, and more. He goes further writing that ‘any situation in which a person’s feelings, desires, or ways of being in the world are not noticed, validated, or responded to respectfully has the potential for engendering shame’. Shame is ubiquitous to say the least.

Jacobs (1995) has highlighted what she terms as ‘Shame Anxiety’. Here an individual approaches contact with expectations that shame will be the result. These anxieties will have a debilitating affect or effect on that encounter and may well result in the loss or reduced effectiveness of the contact moment. These moments may well occur in the therapeutic situation. The therapist may well shame the client who could well be in a vulnerable position by admitting to need therapy. Further the therapist may well be concerned about being shamed themselves. The need for the therapist to understand their own feelings around shame have to be acknowledged and worked through to avoid detrimentally influencing the therapeutic relationship. It may well be easy for a therapist to blame the other for things that go wrong within the relationship to avoid these feelings.

Because of the way I was brought up within my family I could easily feel a deep sense of shame. I was unlovable, unworthy, incapable and bad. All instilled over a long period of upbringing, starting when I was very young. These feelings I could also hide very well, first with the refusal to admit that I was experiencing shame and then with the skill of being able to hide it from others. The reasons being that it is shameful to admit to being ashamed. Imagine the feelings to being exposed by peers in the play ground to being ashamed. This experiencing being very much the double bind situation.

As I have outline above, my experiences fit well with theories of how feelings of shame attack the very fabric of our sense of self (Wheeler 1995) and how this sense is what can be summed up as very low self esteem. I will not say more here  but I acknowledge and agree. Subsequently, because the self is the medium of contact shame is considered a relational problem in that the experience happens in relation with another or more than one other. The importance of this for the Gestalt model will become apparent later.

The above gives an overview of what shame is. I should at this point briefly outline what I see as the difference between shame and guilt. Guilt is the experience of having hurt or injured someone, or done wrong with also the fear of being found out or punished. Often talking about the event or owning the part played, leads to a releasing of the guilt and even a dedication not to repeat the event. If the guilt is interjected and exaggerated then this could lead to a sense of shame that then becomes more of a feeling of an attack upon the self.

Now we can look at how therapy can help those suffering with feelings of shame. The Gestalt method holds the dialogical relationship in high regard. With this methodology the relationship between the therapist and client is viewed with significant importance. The relationship is one of equality to the extent that it can be in therapy and can be examined in the moment and as a developing process. The looking at and emphasis on the relationship is carried out in a gentle inclusive manner; what is happening in the between, what are the feelings and experiences in the contact moment. Attention is directed to the shame as it occurs in the moments of therapeutic dialogue, and not with the expressed wish of going looking for shame. The therapist needs to practice inclusion and presence bringing themselves into the world and being of the client. Further, problems in the relationship could be examined from both sides and not with the view that it is always the responsibility of the client.

Support for the clients internal process and external foundations will be highlighted. The environment outside of therapy and history (Field Theory), of the client could be viewed for contributory factors to the feelings of shame. If apparent these factors then have an opportunity to be dealt with and also changed or avoided. The propensities to hide and to feel shame are factors that should not be lost when working with shame. Not forgetting that the very process of therapy could be shameful and taking new awareness out into the world could again result in being shamed. Difficult questions will need to be asked; can the field/environment be changed or different interactions be found to support the new awareness and methods of interaction that the client is attempting to initiate.

This process of therapy can be long, slow and needs to be very sensitive. I remember in a therapy situation smiling when I was told by a client of an encounter. This smile of mine was experienced as shameful by the client and took a while to repair. The client will need to experience being seen and regarded as human in the moment of contact, counter to the usual experience of wanting to avoid being seen. The client will need to experience validations, respect and a sense of being worthy of the encounter. Polar opposite to the shame potential outlined by Lee above.

The therapist’s ability to being sensitive to even the subtle moments of shaming is important. The therapist will need to look at and acknowledge their own defences and openness to themselves being shamed. All aspects of the therapeutic encounter will need examination and stringent attempts made to recognise what is taking place. The client will need new ways to experiencing contact and seek approval for feelings, desires and needs. These will be required in order to give the client a new sense of themselves. In turn the client will hopefully begin to trust in the encounter, feeling a degree of boldness in order to bring new initiatives and try new ways of being, all based on the trust felt in the relationship. A trust in that no matter what the nature of the contact, the relationship will survive and the therapist will still be there.  The feelings of ‘I am unfit for human company’ will hopefully be transformed into a self-perception of an individual who is worthy of being met and seen, and of one who can experience the feelings of freedom resulting from such an experience.

 

 

 

 

 

 

 

 

Group Therapy … Considerations

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Group members are very varied and diverse and no two groups are the same. When thinking about coming to group therapy it is well worth spending some time thinking about what it entails and what you aim to achieve by being a member.

Maybe there is a need to relate differently to people in your life. Aspects of how we relate as humans is so important to our lives. There are few environments that allow us to be honest and to explore who we are, feeling our way with others who are also doing the same. It can be very challenging to give direct feedback and to listen to others returning feedback.

What is your experience in this group at any moment? You could be experiencing confusion, or finding there is a lack of support and direction that needs attention. There may be a desire to change, to act or behave in a different way, and the group provides an opportunity to practise a new way of relating or to discover how our relationships are formed or damaged.

Group members unfold and grow gradually. This is the process of the group. Safety, confidentiality and trust are most important. Participants are required to look after themselves, but facilitators and group members can support in this regard.

Each person coming to a group brings their total ‘field’. That is, everything that has made them the person they are today, be it past, present or future. It is well worth being yourself and checking on how you feel in the group here and now. It is imperative to use ‘I’ statements and talk about our own experiences and how these affect us today. Be honest, try to come without masks or veils, be prepared to show yourself and be prepared to protect yourself but also to take risks (safe emergency). Try not to have investment in outcomes or conclusions, understand that support will be there and feel able to give support. This can be a central feature of group work.

Very little learning takes place in our comfort zones. The learning edge is at the place where we challenge ourselves. Experiencing ourselves behaving differently can lead to a greater sense of our potential. That behaviour can then be integrated and utilised within the group and outside.

Groups can require a considerable amount of investment in time. Attendance is vital. You may well find yourself thinking about the group throughout your days. This can be productive and also useful. Ascertain what it is you need from the group and may not be getting. Evaluate how you feel in the group and be honest in taking these feelings to the group.

It is not the role of groups or Gestalt facilitators to instruct members in how to be, or to interpret behaviour. Each person has the freedom to decide for themselves how they proceed in the group or in their lives. However, actions will have consequences and these can become apparent in such a diverse environment.

Finally, groups should be fun as well as a place for creativity and awareness. Exercises will be used as and when necessary. These could include meditation, visualisations, body awareness, or working in pairs. Your time should be varied, stimulating and enjoyable.

 

 

 

Personal Therapy Information.

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In personal therapy I practice a Gestalt approach that emphasises that we all discover and form ourselves via our engagement in the world rather than simply through introspection.  The session becomes a laboratory exploring that engagement and forming. I would look at engagement and contact styles, how these are achieved and what creative adjustments are in operation to prevent contact.The organism/environment are closely examined, with the emphasis on how we are in the world and the ‘intentionality’ of contact.

Gestalt has deep philosophical and theoretical roots which supports the process within personal therapy. In addition ‘self’ support is looked at, maybe resurrected and confirmed. Support from the environment and within the session are also established. 

Where many therapeutic approaches focus on change, Gestalt therapy focuses much more on awareness and acceptance, because Gestalt therapy is based on the Paradoxical theory of change. Therefore I would rather support a person toward increasing his awareness. Awareness of how he is functioning and also, of how he might be hindering himself because of the original creative adjustment. Here, for example in the case of depression as a response to life or life events, I could support the person in exploring the different aspects  possible function of the depression in the present life. This starts of course with the acceptance of the depression as the present way of being, as a result of the best possible creative adjustment. It then becomes possible to look at how and causes of the creative adjustment and ways the person can foresee a movement in creating a different way of being that fits with their humanity.

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