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Anxiety Within the Situation: Disturbances of Gestalt Construction

Updated: Feb 1

by Jean-Marie Robine in Gestalt Therapy in Clinical Practice: From Psychopathology to the Aesthetics of Contact (Gestalt Therapy Book Series 2). Gianni Francesetti, Michela Gecele, Jan Roubal, and Leslie Greenberg

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Anxiety Within the Situation in Gestalt Therapy in Clinical Practice
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If we see psychology as the study of human experience, then psychopathology is the study of the dysfunctions of that experience. If we regard human experience as essentially unique since it includes all the contact operations that link human beings with their world, then the study of the dysfunctions of experience will show us some of the ways in which experience may cease to be unique, presenting instead a number of flections (Loc: 11,278)

It seems to me more appropriate than the term “contact interruptions”, or even “resistances” as (Loc: 11,283)

A psychotherapeutic approach adopted for its focus on the concept of experience can be linked to a psychopathological description of the flections of this experience, (Loc: 11,286)

1. Anxiety in Gestalt Therapy (Loc: 11,294)

1.1. Anxiety and Excitement

“excitement” (Loc: 11,297)

is born with the emergence of each figure and tends to be attached to the “object” which is contacted, so much so that it would be pointless to locate it in either the organism or in the environment. (Loc: 11,300)

Excitement is maintained, increases and then diminishes during the entire contact sequence. However, this excitement may be inhibited or blocked, for various reasons, resulting in anxiety. (Loc: 11,302)

1.2 Anxiety and Support (Loc: 11,306)

the perspective pioneered by Laura Perls (2001), which links anxiety to the absence of necessary support during the contact experience. (Loc: 11,309)

if an interruption occurs (Loc: 11,310)

in the context of inability to engage with the challenges (Loc: 11,311)

or fear of moving on to the next, (Loc: 11,311)

result is anxiety. (Loc: 11,312)

prevents the subject from drawing the necessary supportive (Loc: 11,312)

from within (Loc: 11,312)

or from the environment. (Loc: 11,312)

1.3. Can We Speak of Contact “Interruptions”? (Loc: 11,317)

the concepts of confluence, introjection, projection, retroflection and egotism have a controversial history within Gestalt therapy. (Loc: 11,319)

In the second, theoretical part of the founding text – Gestalt Therapy (1951) (Loc: 11,323)

phenomena were addressed in the last chapter, Loss of Ego-Functions. (Loc: 11,323)

the authors show how these modalities of contact (introjection, projection etc.) may constitute a pathological experience when accompanied by a loss of ego-functioning. (Loc: 11,325)

it is experience which may be inflected – or even considered pathological – when two factors operate concurrently: (Loc: 11,327)

loss of ego-function and the presence of one of these modalities. (Loc: 11,328)

use of the expression “contact interruptions” (Loc: 11,329)

remember that contact has a specialised technical meaning within the theory of Gestalt therapy: it refers to figure formation. (Loc: 11,330)

not contact itself that is interrupted but the forms it takes when influenced by one of these flections of experience. (Loc: 11,331)

1.4. Anxiety in Gestalt Construction (Loc: 11,343)

1.4.1. Emergence of a Figure versus Confluence (Loc: 11,345)

fore-contact phase, the body and its primary and secondary physiological processes form the ground. (Loc: 11,347)

Within the on-going situation, (Loc: 11,348)

consciously or not, “something” emerges. (Loc: 11,349)

“id of the situation”, (Loc: 11,349)

concept of the “id” refers precisely to this pressure, and to the awareness of pressure, (Loc: 11,351)

shorn of any speculation as to its possible origin. (Loc: 11,352)

The id-function is a modality of the self, (Loc: 11,352)

inseparable from awareness, (Loc: 11,353)

emerges from the figure and constitutes the “what-comes-next” of the situation. (Loc: 11,353)

during this phase of the sequence the self is primarily a function of physiology and thus forms part of the organism, (Loc: 11,354)

At other times, (Loc: 11,355)

the self appears much more clearly as a function of the field, or more precisely as «the way the field includes the organism» (Perls, Hefferline and Goodman, 1951, II, 12, 1). (Loc: 11,355)

it is the appetite, or the environmental stimulus which awakens it, which is the figure. (Loc: 11,357)

1.4.2. Flections I (Loc: 11,359)

The acknowledgment of an appetite or a desire, (Loc: 11,361)

produce excitement. (Loc: 11,363)

Hence they may lead to anxiety which prevents the figure emerging. (Loc: 11,363)

This interruption of the sequence, (Loc: 11,364)

is more a failure to start, takes place through confluence. (Loc: 11,365)

Refusing to allow the figure to emerge is tantamount to maintaining, or seeking, confluence (Lapeyronnie and Robine, 1996). (Loc: 11,365)

available modalities for maintaining confluence are similar to repression, (Loc: 11,367)

chapter XIV (1951). (Loc: 11,368)

One (Loc: 11,369)

functions of maintaining this confluence relates to anxiety about individuation and differentiation: (Loc: 11,370)

becoming aware of one’s desire means adopting the first person singular, (Loc: 11,370)

Confluence, (Loc: 11,371)

removes this risk. (Loc: 11,372)

maintaining confluence makes it difficult to transform physiological into psychological experience, (Loc: 11,375)

thus it forces experience to stay at the physiological level of unawareness. (Loc: 11,376)

repressed excitement then remains exclusively physical, (Loc: 11,376)

sensation cannot become affect and nor can affect become feeling or emotion. The pathology which may result tends to see the body as an object, (Loc: 11,377)

during this phase that excitement may come to a halt and anxiety may become fixed within the body, (Loc: 11,378)

often described as psychosomatic conditions (Loc: 11,379)

Less severe disturbances linked to repeated interruption of this phase (Loc: 11,381)

manifested in various forms of immaturity – or regression (Loc: 11,381)

absence of contact with the environment deprives the organism of novelty and hence interrupts growth. (Loc: 11,382)

1.4.3. Excitement of One’s Own Desire versus Introjection (Loc: 11,401)

The emergence of a figure from the ground, (Loc: 11,403)

initiates a stage of the contact sequence where there is a dynamic relationship between figure and ground. (Loc: 11,404)

the particular feature of the excitement of this stage is that it brings the organism out of a state of (Loc: 11,406)

rest and silence (Loc: 11,407)

into an awakening of desire. (Loc: 11,407)

This nascent growing appetite needs an “object”. (Loc: 11,410)

that is, some feature of the world to be contacted, to take up in order to meet, appropriate, and assimilate. (Loc: 11,411)

Perls (1942) used the term introjection to refer solely to a “pathological” process, the healthy equivalent being “assimilation”. (Loc: 11,414)

Today (Loc: 11,414)

a tendency to apply the term introjection to the entire phenomenon, (Loc: 11,415)

grasping the world around us and appropriating it, (Loc: 11,415)

may lead either to assimilation (Loc: 11,416)

or construction of an introject (Loc: 11,416)

If the (Loc: 11,416)

object becomes fixated in the form of a “foreign body”, we term this an introject. (Loc: 11,417)

1.4.4. Flections II (Loc: 11,423)

«coercion is incompatible with excitement», (Loc: 11,424)

any aspect of the environment begins to exercise coercion, (Loc: 11,425)

the excitement linked to the upsurge of desire becomes immobilised. (Loc: 11,426)

heightening of this excitement produces anxiety. (Loc: 11,426)

desire itself cannot be recognised, (Loc: 11,426)

Introjection occurs when «the self [...] displaces its own potential desire or appetite with someone else’s» (Perls, Hefferline and Goodman, 1951, II, XV, 5), (Loc: 11,427)

a substitute for creating its own appetite, desire, or meaning. (Loc: 11,428)

Affect is then turned back before it can be recognised and thereby felt. (Loc: 11,428)

Introjection thus formed can never become assimilation. (Loc: 11,429)

one most frequently encountered (Loc: 11,434)

is found in patients who present narcissistic disturbances of experience. (Loc: 11,435)

constraint (Loc: 11,435)

in their early years to substitute the significant parent’s desire for their own desire in order to survive emotionally forces them into the “habit” of ignoring their own desire, (Loc: 11,435)

sometimes confusing it with an absence of desire, (Loc: 11,437)

constantly seeking introjection: the patient’s identity is replaced by introjects, (Loc: 11,437)

aware that he had been attempting to replace his parents with his friends, (Loc: 11,444)

his friends by me, (Loc: 11,445)

who would be able to show him how he should feel, think and act in any situation. (Loc: 11,445)

But what do I feel? Nothing! (Loc: 11,446)

All I do is act the way people expect me to in the situation”. (Loc: 11,447)

1.4.5. Perception of the Environment versus Projection (Loc: 11,466)

If the excitement of desire has not been interrupted (Loc: 11,468)

desire can once again fade into the background and excite the ground as a resource for construction of the current Gestalt. (Loc: 11,469)

at this point in the sequence, figure formation requires an investment of energy from both poles of the field, the organism and the environment. (Loc: 11,471)

desire which formed the figure in the previous phase gives (Loc: 11,472)

way to the object, or a series of possible objects. (Loc: 11,472)

a particularly sensitive – and anxiety-creating – moment as the figure migrates from one pole of the field (the organism) to the other (the environment), (Loc: 11,472)

“Moving out” immediately recalls the Latin equivalent: “ex-movere”, from which “emotion” is derived. (Loc: 11,475)

This moment is (Loc: 11,475)

the phase when emotion is most crucial. (Loc: 11,475)

Gestalt therapy sees emotion as a kind of impact between the state of the organism and the state of the environment: (Loc: 11,476)

field» (Perls, Hefferline and Goodman, 1951, II, XII, 6). (Loc: 11,478)

for emotion to exist, it is necessary to «accept the excitement and face up to the environment», meaning «relating appetite or other drive with a vaguely conceived object» (Perls, Hefferline and Goodman, 1951, II, XII, 5). (Loc: 11,479)

confronting and adapting to the environment (Loc: 11,481)

is a process of trial and error involving (Loc: 11,482)

adaptations which commonly use projection as a tool for orientation (Loc: 11,482)

intuition, premonition, or simply the capacity to apply to current experience knowledge derived from previous experiences is part of projection in its broadest sense. (Loc: 11,484)

1.4.6. Flections III (Loc: 11,487)

In projection as defined in Gestalt therapy, (Loc: 11,493)

is more a question of an unwitting refusal (denial, impossibility…) to own one’s own affect, emotion, and feelings and their accompanying representations. (Loc: 11,493)

the subject constructs a screen in relation to the field. (Loc: 11,495)

features of the environment fail to register because the environment is reduced to virtual images created by the subject him/herself. (Loc: 11,496)

Any form of denial will entail projection, (Loc: 11,499)

contributes to the elaboration of compulsive rituals and reaction formations, (Loc: 11,500)

neurotic guilt, (Loc: 11,501)

jealousy, (Loc: 11,501)

and others. (Loc: 11,501)

1.4.7. Going Towards versus Retroflection (Loc: 11,512)

able to perceive and create the environment, excitement may then truly engage with the situation: go towards and contact fully. (Loc: 11,514)

Identifications and alienations progressively restrict the field of possibilities, (Loc: 11,515)

this going-towards may suscitate anxiety or dread, (Loc: 11,515)

this function «originally directed towards the world by the individual, changes direction and turns back on its originator» (Perls, 1942). (Loc: 11,516)

Going-towards, ad-gredere in Latin, corresponds to the Gestalt conception of aggression (Loc: 11,517)

a beneficial, self-expressive, and creative human power to make something or to make something happen, (Loc: 11,518)

willing to give oneself back to the world as well as to receive (Loc: 11,519)

(Miller, 1994). (Loc: 11,519)

retroflection is the contacting modality which makes it possible to avoid the anxiety of aggression. (Loc: 11,521)

is then turned back onto «the only available harmless objects in the field, his own body and personality» (Perls, Hefferline and Goodman, 1951, II, XV, 7). (Loc: 11,522)

retroflection enables engagement to be slowed down, making it possible to readjust the emotion, correct the ground and hence reconsider the emotion. (Loc: 11,523)

is called self-control, and is linked to the exercise of will. (Loc: 11,524)

appropriate to slow down or not engage in aggressive activity, considering the context (Loc: 11,526)

A retroflection may then rightly be considered a creative adjustment. (Loc: 11,526)

Thinking (re-flecting) is a type of retroflection, talking to yourself. (Loc: 11,528)

Thinking as a way of preparing to relate is not the same as thinking as a way of avoiding action. (Loc: 11,530)

1.4.8. Flections IV (Loc: 11,533)

retroflection can intervene (Loc: 11,534)

[the] current Gestalt with or without the intervention of the ego function, (Loc: 11,535)

with or without awareness, (Loc: 11,535)

this is what makes the difference. (Loc: 11,535)

When (Loc: 11,536)

aggression, (Loc: 11,536)

cannot be expressed (Loc: 11,536)

may turn into hostility (Loc: 11,536)

fear of destroying produces anxiety, (Loc: 11,537)

destructiveness will then turn towards (Loc: 11,537)

available objects: (Loc: 11,537)

own body and personality. (Loc: 11,537)

retroflection will be manifested as self-destructive behaviour, (Loc: 11,538)

self-harming (Loc: 11,538)

obsessions (Loc: 11,538)

psychosomatic illnesses, (Loc: 11,539)

suicide (Loc: 11,539)

masochism, (Loc: 11,539)

compulsion to fail (Loc: 11,539)

remorse, (Loc: 11,539)

resignation (Loc: 11,539)

self-mastery. (Loc: 11,539)

Perls made a clear distinction between repression and retroflection: (Loc: 11,540)

of the latter «little material is lost (Loc: 11,541)

only a reorientation (Loc: 11,541)

the conflicts which induced the retroflection are near the surface» (Perls, 1942, III, 8). (Loc: 11,541)

1.4.9. Letting Go versus Egotism (Loc: 11,556)

The concept of egotism (Loc: 11,557)

is ignored in most theoretical and clinical texts, (Loc: 11,558)

In order to attain final contact, spontaneity must be able to supersede the deliberateness which often dominates (Loc: 11,560)

through loosening control, letting-go, daring to finish the action undertaken, opening the barriers to the encounter with the object contacted, (Loc: 11,561)

allowing the I-Thou to become briefly a We. (Loc: 11,562)

The problem with this control, (Loc: 11,563)

is that it is not itself under control. (Loc: 11,563)

excess of ego invested in this phase of the self, (Loc: 11,564)

the ego finds it impossible to choose not to exercise control. (Loc: 11,564)

excess of ego goes hand in hand with a loss of ego function. (Loc: 11,565)

see egotism as a specific form of retroflection inasmuch as (Loc: 11,566)

«Any act of deliberate self-control during a difficult engagement is retroflection» (Perls, Hefferline and Goodman, 1951 II, XV, 7). (Loc: 11,567)

Egotism manifests itself through diffidence, scepticism or slowness. (Loc: 11,571)

1.4.10. Flections V (Loc: 11,573)

in certain situations, the approach of final contact produces so much anxiety that egotism is used as a final brake to avoid it. (Loc: 11,575)

often occurs towards the end of therapy, when “introspection” has become second nature (Loc: 11,576)

often found, (Loc: 11,576)

in individuals presenting with narcissistic disorders of experience. (Loc: 11,577)

anxious when faced with letting go, anxious about loss of control, anxious about opening up to the other, anxious about being swallowed up by the We of the encounter, or anxious about being subsequently abandoned, they cut themselves off from the environment and reduce it to a stock of knowledge they can use to increase their power and control. (Loc: 11,577)

Isadore From emphasized that using any form of “we”, even at the purely verbal level may arouse anxiety in personalities who present with serious disturbances of their narcissistic experience. (Loc: 11,581)

Conclusion: Psychotherapy as an Emergency Situation (Loc: 11,590)

When the organism finds itself in a new situation of disequilibrium, danger, threat, survival, (Loc: 11,592)

a situation (Loc: 11,592)

the holistic approach describe (Loc: 11,592)

as an emergency, (Loc: 11,593)

formulates a global adaptive response: (Loc: 11,593)

through repeated failures to re-establish equilibrium (Perls, Hefferline and Goodman, 1951, II, III, 9), (Loc: 11,596)

the adaptive Gestalt may become chronic at a low-key level. (Loc: 11,598)

tension (Loc: 11,598)

danger and frustration, (Loc: 11,598)

mutually reinforce (Loc: 11,598)

to the point of neurosis. (Loc: 11,599)

«a chronic low-grade emergency», is one definition of neurosis. (Loc: 11,599)

In this situation, the contact boundary (Loc: 11,601)

simplify (Loc: 11,601)

to the two emergency functions (Loc: 11,601)

deliberate blotting-out (Loc: 11,602)

non-deliberate hyperactivity. Note:(Perls, Hefferline and Goodman, 1951, II, III, 9), (Loc: 11,602)

This disturbance (Loc: 11,608)

corresponds to (Loc: 11,609)

a disturbance of (Loc: 11,609)

(perception and proprioception), Note:orientation (Loc: 11,609)

which brings (Loc: 11,609)

a disturbance (Loc: 11,609)

(psychomotor activity). Note:manipulation (Loc: 11,610)

the neurotic state is the response to a non-existent chronic low-grade emergency, (Loc: 11,611)

the aim is to concentrate on (Loc: 11,612)

existing high-grade emergency (Loc: 11,612)

which the patient can actually cope and (Loc: 11,612)

grow» 1951, II, IV, 12). (Loc: 11,613)

the full meaning of the concept of experiment (Loc: 11,614)

in using the actual emergency, or even creating a high-intensity experimental emergency in situ. (Loc: 11,615)

the point is for the patient to feel the behaviour in its very emergency use and at the same time to feel that he is safe because he can cope with the situation» (ibidem). (Loc: 11,617)

Gestalt therapy, (Loc: 11,619)

cannot dissociate the tools (Loc: 11,620)

in diagnosis from (Loc: 11,620)

intervention, (Loc: 11,620)

Comment by Myriam Muñoz Polit (Loc: 11,624)

description of what is dysfunctional instead of (Loc: 11,627)

pathological (Loc: 11,628)

more appropriate (Loc: 11,628)

of Gestalt Therapy. (Loc: 11,628)

should definitively abandon the use of the concept of “psychopathological”. (Loc: 11,628)

avoid any notion that takes us (Loc: 11,629)

to the idea (Loc: 11,629)

the person with inflections, (Loc: 11,629)

is “sick”. (Loc: 11,630)

the Gestalt focus is (Loc: 11,630)

an educational model (Loc: 11,630)

not (Loc: 11,630)

a medical model. (Loc: 11,630)

medical model has set its sights on curing, (Loc: 11,631)

educational model emphasizes (Loc: 11,632)

development of potentialities, (Loc: 11,633)

the vision of Gestalt Therapy: human beings are constructive by nature and require support from their environment for their development. (Loc: 11,640)

descriptions of the sensations that may be involved in the process of contact and figure/ground formation. (Loc: 11,645)

their equivalent, in terms of feelings, would be anxiety and enthusiasm. (Loc: 11,646)

human beings share from birth basic emotions that take the form of feelings (Loc: 11,649)

these feelings are fear, affection, sadness, anger, and happiness, (Loc: 11,650)

words, there are five “families” (Loc: 11,651)

from which all emotional experiences are born, (Loc: 11,651)

anxiety, which is a sensation, and anguish, its corresponding feeling, belong to the family of fear, where the spontaneous reaction is to seek protection and withdraw from any threats. (Loc: 11,654)

excitement, which is a sensation, and enthusiasm, its corresponding feeling, stem from the combination of two families, fear and happiness, where the spontaneous reaction is ambivalent, with threat coexisting alongside an attraction to novelty. (Loc: 11,655)

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