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The Three Perspectives Diagnostic Model

Book cover of 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

(How Can Diagnostics Be Used In The Gestalt Approach And In Psychiatry Without An Unproductive Competition)

by Jan Roubal in Gestalt Journal of Australia and New Zealand, 2012, Vol 8 No 2 Pages 21-53. © 2012, GANZ

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The Three Perspectives Diagnostic Model
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The Three Perspectives Diagnostic Model (How Can Diagnostics Be Used In The Gestalt Approach And In Psychiatry Without An Unproductive Competition)

Gestalt therapists need to conceptualize their clinical work in order to intentionally differentiate their approach to different clients. (Page 1)

Diagnosing is a natural and necessary part of the therapeutic process. (Page 1)

it is a difficult task to build a coherent diagnostic system in Gestalt therapy, (Page 1)

Gestalt therapists use (and often combine) different perspectives of looking at the clinical situation. (Page 1)

The author uses his psychiatric background to present the Three Perspectives Diagnostic Model (Page 1)

The text does not deny there is an epistemological conflict between medical and Gestalt approaches. (Page 2)

However, it does not want the conflict to lead into an unproductive fight: (Page 2)

the text offers the observer a tool for being more aware from which place he is observing and what perspective other places can offer. (Page 2)

When I meet a client (Page 2)

I experience contact (Page 2)

I listen and watch. (Page 2)

different questions arise and vanish: (Page 2)

(Note) What is happening here? What does the therapeutic situation say about the client and about me in the moment? What symptoms do I see? (Page 2).

the client also tells me about the context of his life (Page 2)

and I start to recognize relational patterns; (Page 2)

My questions try to cast light on the therapeutic situation from different angles, different perspectives. (Page 2)

my awareness and understanding have more dimensions and correspond more to the rich complexity of the situation. (Page 2)

It is important not only to ask questions and form a hypothesis but also to be aware from what point of view I am asking. (Page 2)

When a therapist meets a client, he1 encounters an enormous amount of information (Page 2)

For processing all this information a therapist needs filters and concepts that help him organize it in a meaningful way. (Page 2)

necessary for (Page 2)

contact which is healing and not re-traumatising, (Page 2)

as the foundation for responsible creativity on the part of the therapist. (Page 2)

There is a distinct effort present today (Page 2)

to elaborate a method (Page 2)

enable the assessment of an individual client and facilitate the clinical psychotherapeutic treatment (Page 2)

using theoretical concepts. (Page 2)

There is an effort to create psychotherapeutic diagnostics (e.g. Bartuska et al., 2008). (Page 2)

This, as opposed to medical diagnostics, is not a fixed system of boxes (Page 2)

is a system of clues helping the (Page 2)

therapist to continuously orientate himself in the ongoing therapeutic process (Page 3)

psychotherapeutic diagnostics is related to another frequently used term, which is case formulation. (Page 3)

Gestalt literature follows this trend although the Gestalt approach is not much visible in psychotherapeutic overview publications. (Page 3)

crucial for Gestalt therapy not to fix its eyes only upon itself but to engage in more of a mutually inspiring dialogue with other approaches. (Page 3)

According to the theory of Gestalt therapy, the individual is defined and grows by the processes occurring at the contact boundary with his surroundings. (Page 3)

the Gestalt approach itself is defined and developed on its borders (Roubal, 2010), both in contact with other psychotherapeutic approaches and also with the medical world. (Page 3)

this, I recommend two new publications where Gestalt authors can find a great deal of inspiration (Page 3)

Psychotherapeutic Diagnostics (Bartuska at al., 2008) (Page 3)

practice? In the book, the Gestalt approach is represented only by a largely theoretical chapter on diagnostics in Gestalt Theoretical Psychotherapy (Stemberger, 2008) (Page 3)

The second edition of the Handbook of Psychotherapy Case Formulation (Eells, 2007) presents case formulation (Page 3)

The book purveys an overview of case formulations in diverse psychotherapeutic approaches that are then compared throughout the conclusion in the search for common ground. (Page 3)

includes a valuable chapter dealing with the topic of case formulation in Emotion-Focused Therapy (Greenberg, Goldman, 2007), (Page 3)

The Gestalt approach is not directly represented, however2 (Page 4)

I want to present here a proposal that focuses primarily on diagnostics in Gestalt therapy. (Page 4)

1.2. Personal Experience with Diagnosing (Page 4)

When I was still a student of medicine, (Page 4)

psychiatry, I spent a great deal of time memorizing the diagnostic criteria (Page 4)

Later on, (Page 4)

I saw how easily the diagnosis may be bent and somewhat adjusted. (Page 4)

I did not want to take part in the objectification and pathologising of people (Page 4)

I did not want my own I and the client’s You to “freeze into a thing among things” (Buber, 1996) for each other. (Page 4)

clients. I was eager to grasp the psychotherapy approach, especially the Gestalt (Page 4)

which looks at symptoms as a means of creative adjustment in relationships. (Page 4)

When I thought of my clients in the complex terms of the field theory paradigm, I was not understandable to my colleagues from the psychiatric ward (Page 4)

it. I noticed I was losing my accurate, sharp diagnostic approach. (Page 4)

I could make good contact with my clients, but I was not a good diagnostician. (Page 5)

I found out that when I left the objectivising and pathologising approach of medical diagnostics behind, I started to lose a sharp diagnostic view (Page 5)

Thus, I also lost the way of intentionally and conceptually differentiating between approaches to clients with different kinds of suffering. (Page 5)

a Gestalt therapist might benefit from using the sharp and precise approach of diagnostic labelling (Page 5)

and stay open to the relational and process-oriented perspective of the Gestalt approach. (Page 5)

2. Gestalt Approach and Diagnostic Assessment (Page 5)

2.1. Basic Assumptions and History (Page 5)

Gestalt diagnosis is not pointed at fixed conclusions (Brownell, 2010) (Page 5)

serves as a flexible and momentary working hypothesis (Höll, 2008), (Page 5)

Diagnosis is most useful when kept descriptive, phenomenological and flexible (Joyce and Sills, 2006). (Page 5)

the Gestalt therapist co-creates and continuously corrects the diagnosis through dialogue with the client. (Page 5)

the phenomena of the interaction between the therapist and the client are important objects of the therapist´s explorative interest. (Page 5)

Every experience is random, changeable, amorphous and chaotic in the moment of its birth (Melnick, 1998). (Page 5)

Throughout history, Gestalt therapists either shunned diagnosis5 or they strived to create its specific Gestalt version (Brownell, 2010). (Page 6)

The Gestalt approach has traditionally stood against the objectifying, pathologising and depersonalised labelling of people (Perls et al., 1951), (Page 6)

However, (Page 6)

the Gestalt approach was still not able to emancipate itself from the concept of medical diagnostics. (Page 6)

it is a similarly objectifying and pathologising perspective, only using different diagnostic labels. (Page 6)

(Note ) for example, descriptions of “introjectors” or “retroflectors” (Perls et al., 1951; Polster and Polster, 1974), or of people who somehow interrupt the contact cycle (Zinker, 1978), (Page 6).

Gestalt therapists realize that diagnosing cannot be avoided (Page 6)

either to do it inadvertently and negligently, or thoughtfully and with full awareness (Yontef, 1993). (Page 6)

of the risk that they would treat the diagnosis instead of the client and (Page 6)

become depersonalized and antitherapeutic. (Page 6)

there are attempts to constitute a diagnostic system (e.g. Delisle, 1991; Swanson and Lichtenberg, 1998; Melnick and Nevis, 1998; Baalen, 1999; Fuhr et al., 2000; Francesetti and Gecele, 2009; Dreitzel, 2010) (Page 6)

These are attempts to create a classification (Page 6)

which is quite difficult as psychopathological and Gestalt terminology each originate in different paradigms. (Page 6)

clearly defined models from Gestalt therapy theory are often used for diagnostics, such as the contact cycle and the styles of contact. (Page 6)

There is a risk, though, that models based, for example, on the contact cycle or the contact styles might retreat from the theoretical basis of Gestalt therapy. (Page 7)

There is hardly any difference in, for example, labelling the client as “depressive” or as someone who “is interrupting the contact cycle between the stage of mobilization of energy and action by retroflection”. (Page 7)

Brownell (2010) poses a question: “How do we speak about the client without doing damage to the client?” (Page 7)

So, how to preserve clarity, comprehensibility and diagnostic accuracy whilst remaining faithful to the original paradigm of the Gestalt approach? (Page 7)

Existing Gestalt diagnostic systems focus first on describing the content of diagnosis – they focus on what Gestalt therapists might diagnose. (Page 7)

This article supplements them by focusing on the very process of diagnosing – on how we diagnose, (Page 7)

2.2. Metaposition (Page 8)

A diagnosing expert with a maximum “objectivising” (Page 8)

client. (Page 8)

Moments of full I-You contact (Buber, 1996) in the process of therapy represent the other extreme. (Page 8)

For psychotherapeutic work, maintaining just one of these extreme positions is unsustainable. (Page 8)

In practice, in the course of the psychotherapeutic process we move up and down the scale between these polarities. (Page 8)

For a better description of the therapist’s position in the process of diagnosing I use and adapt the model which Ernst Knijff (2000) calls “the therapeutic dance”. (Page 8)

image of metaposition of the therapist

Figure 1: Metaposition of the therapist (Page 8)

The client and the therapist mutually respond to each other (Page 9)

they co-create fixed gestalts. (Page 9)

The therapist (Page 9)

temporarily step out of these fixed gestalts (Page 9)

using his awareness. (Page 9)

awareness he takes a position above the level of reacting and adopts a “metaposition” (see Arrow 3). (Page 9)

mapping his awareness (a.), (Page 9)

forming therapeutic hypotheses (b.), (Page 9)

considering possible interventions (c.). (Page 9)

being in metaposition, (Page 9)

relates to the client through the observational I-it mode (Buber, 1969). (Page 9)

he comes back and is ready and fully present to meet the client again (see Arrow 4); (Page 9)

then back in the dialogical mode, which is open to I-You encounters (see Arrow 2). (Page 9)

On the content level, it is a matter of the mutual transfer of information; (Page 9)

on the level of process, it is a matter of the mutual pattern of relating. (Page 9)

the therapist and the client exchange more than just information. (Page 9)

They mutually react and, to a great extent, replay their usual patterns of relating, or fixed gestalts. (Page 9)

the therapist (Page 9)

personally experiences how the relational field in which the client lives is organised. (Page 9)

the therapist experiences and what he does is a function of the field and might be used as diagnostic information (Roubal, 2009). (Page 9)

uses his awareness (Page 9)

as another source of information. (Page 9)

especially important in the initial stage of therapy. (Page 9)

This article focuses on the next step – the process of diagnosing that structures and classifies the information. (Page 9)

process. Metaposition is also a place where the therapist considers possible interventions. (Page 10)

stage of forming the hypotheses, (Page 10)

3. Three Perspectives Diagnostic Model (Page 10)

The following model describes the three perspectives most frequently used by Gestalt therapists (see Figure 2). (Page 11)

image of Three Perspectives Diagnostic Model

This type of diagnosing is of a dialogical nature. (Page 11)

The model is cyclic; a therapist fluidly changes the perspectives to obtain a complex, multidimensional diagnostic picture. (Page 12)

3.1. Psychopathology Perspective (Page 12)

Is it possible for a Gestalt therapist to see his client as, for example, depressive, obsessive or borderline? (Page 12)

the therapist keeps the psychopathology diagnosis as a hypothesis and knows he is looking at the therapeutic situation from just one of several possible perspectives. (Page 12)

We may say that he takes up the Newtonian paradigm, which is rooted in the assumption of objective8 observation of the phenomenon; (Page 12)

so creates the Psychopathology Perspective. (Page 12)

The therapist discriminates and labels the client´s difficulties, (Page 12)

The present therapeutic relationship becomes the subject of diagnosing and therapy (Francesetti and Gecele, 2009). (Page 13)

The therapist asks himself questions related to medical classification systems: (Page 13)

(Note) “What symptoms do I observe? Do I note psychotic, depressive, anxious or other symptoms in the client? Do I see any displays of personality disorder?” (Page 13).

The therapist can also make use of metaphors or partial Gestalt models (Page 13)

(contact styles, contact cycle, functions of the self, polarities, fixed Gestalts and so forth). Some possible questions the therapist poses are: “What contact styles is the client using and how is he applying them to prevent fluent contact and the accomplishment of his needs? How is the contact cycle deformed? At what stage does the client interrupt the cycle? Which stages does he skip?” (Page 13). (Note)

The Psychopathology Perspective is focused on the disorders and dysfunctional strategies of the client. (Page 13)

the therapist has the possibility of validating his thoughts with the client, to diagnose in a dialogical way. (Page 13)

questions such as: “What troubles you the most?”, “What diagnosis or labels did you get in the past and what is your opinion of them?”, “What do you think – why are you having these troubles? How do you understand the situation?”(Page 13). (Note)

3.1.1. The Psychopathology Perspective: Diagnostic Case example (Page 13)

From the Psychopathological Perspective I create various working hypotheses and infer possible interventions from them: (Page 14)

Medical hypotheses: I observe Martin’s obviously anxious state, I hear about his panic attacks and chronic backache, I notice the obsessive compulsive personality traits. (Page 14)

Gestalt theoretical hypotheses: After initial contact on the cliche level is (Page 14)

established, the overall interaction becomes gradually more and more disturbed and both of us find ourselves in a state of isolation. The contact cycle of Martin’s experience is markedly set back at the stage of energy mobilization; action is delayed and is not aimed at establishing contact (but at the fulfillment of a task). Martin’s typical contact style is egotism; the chronic backache implies somatised retroflection. The rational processing of a situation predominates for Martin; when it comes to focusing on emotion, he avoids it. (Page 15)

There are some guidelines for therapeutic attitude that arise from the Psychopathology Perspective of diagnosis: (Page 15)

- Martin enters psychotherapy to “try it”. (Page 15)

accept his perspective to begin with – to focus on the problem, the symptom, to stay within the frame of rational thinking. (Page 15)

offer him a lecture on panic attacks and possibilities of coping (e.g. controlled breathing). (Page 15)

The therapist might only very carefully and slowly examine the relationship and experiential areas of Martin´s life (emotion, body) as this approach is new and threatening to him. (Page 15)

- It would be good to give him time and space for his inner elaboration (egotism). And gradually also offer him a means of getting out of it through contact facilitated by the authentic interest in his person. (Page 15)

The therapist can notice the moments when Martin is gathering energy and go to meet him in such situations. (Page 15)

3.2. The Contextual Perspective (Page 15)

There are two ways to extend the therapist’s view (Page 15)

when moving from the Psychopathology Perspective to the Contextual Perspective (Page 15)

Firstly, the therapist does not focus solely on the client as an isolated person, but sees him as a part of a manifold system of relations11. (Page 16)

Secondly, he does not understand the client’s suffering as a dysfunctional disorder but as a means of survival. (Page 16)

From the Contextual Perspective the therapist sees the client as a member of a system and observes the roles he takes within the system; (Page 16)

he explores the function of the client’s phenomenology (Page 16)

in a wider context. (Page 16)

From the Contextual Perspective we look at the therapeutic situation and see individuals that have certain roles within a system. (Page 16)

The Field Theory Perspective seems similar but there is a significant difference, (Page 16)

from the Field Theory Perspective we do not see individuals but rather events happening in “the between”; we do not see causality (Page 16)

but rather the interconnectedness of all mutual influences (including the diagnosing therapist) and the permanent process of co-creation. (Page 16)

From the Contextual Perspective a client, a therapist and “symptoms” play a role in the system (Page 16)

from the Field Theory Perspective they are functions of the field. (Page 16)

The contextual (or systemic) point of view defines objects as existing independently outside the field and the context is added (Page 16)

field theory assumes there cannot be anything that is not “of the field” (Yontef, 1993). (Page 16)

The contextual perspective: focus on roles within a system of relations (Page 16)

(Note) • The therapist asks: What is the role of the client’s phenomenology (seen as a “symptom” form the Psychopathology Perspective)? • The therapist inquires about the function symptoms had performed in the client’s personal history. How had they served him? What have they protected him from? What needs have they satisfied? • The therapist also examines the purpose they serve in the client’s present relationships (including the therapeutic one). What are the “secondary benefits” and limitations the symptoms bring? • The therapist applies a systemic Contextual Perspective and focuses on the dynamics of the roles and ways of relating within the system to which the client belongs. (Page 17).

The Contextual Perspective of diagnosis describes how the client has functioned and is functioning in various systems (the original and present family, job etc.). It maps out the role the client’s phenomenology (Page 17)

A person thus repeats the roles which proved useful and result in the satisfaction of personal needs. (Page 17)

adopted, creating each person’s unique being in the world and the particular way in which each person relates to his surroundings. (Page 17)

The original adaptation and functional way of relating has turned into a rigid form that the client automatically applies in situations that require a different approach. (Page 17)

This leaves his needs unsatisfied. (Page 17)

Diagnoses made from the Contextual Perspective are descriptions of such rigid roles and ways of relating. (Page 17)

The Contextual Perspective of diagnosis focuses on the client´s inner and outer sources of support. (Page 17)

The therapist and the client co-operate as they co-create the diagnostic description from the Contextual Perspective together. (Page 18)

(Note )The therapist may ask the client: “How has your suffering, or this particular role or way of relating you described helped you in your life? What is its origin? What is its present contribution? At what price?” (Page 18).

3.2.1. Contextual Perspective: Diagnostic Case Example (Page 18)

Taking the Contextual Perspective, I broaden my view and think of Martin’s phenomenology (Page 18)

as a part of the client´s relationship systems and as a kind of survival mechanism. (Page 18)

There are some guidelines for the adoption of the appropriate therapeutic attitude that arise from the Contextual Perspective of diagnosis: (Page 18)

To be on the safe side, it is important to stick with the level of rational elaboration at first as it is natural for Martin. (Page 18)

slowly I can also offer him a new point of view on his current problems. (Page 18)

examine his personal history (Page 18)

map the important stages and critical points of his life (Page 18)

Another strategy might focus on his communication style. (Page 19)

together may map how Martin managed periods of solitude, what helped him. (Page 19)

explore how this experience has influenced his present relationships. (Page 19)

sources of coping and what is the price he pays for his safe, conservative way of life? (Page 19)

3.3. The Field Theory Perspective (Page 19)

to define the Field Theory Perspective (Page 19)

the language we must use for the description is meant to fix subjects and structure. (Page 19)

we want to describe “the between” process. (Page 19)

Moreover, there are different understandings of field theory in Gestalt literature (Staemmler, 2006) (Page 19)

the concept of field theory is sometimes mixed up with the systemic point of view; (Page 19)

differences between the concepts of “being of the field” and “being in the field” are often overlooked (Yontef, 1993). (Page 19)

when we explicitly distinguish the Psychopathology and Contextual Perspectives (Page 19)

We can adopt the field theory outlook, in which concepts like holism, organismic self-regulation and present-centredness are all woven together (Parlett, 1991). (Page 19)

There is no client and no therapist as isolated persons, (Page 19)

causality. Every memory of a client, every so called “counter-transferential” experience of a therapist, every diagnosis that comes to a therapist’s mind – all these are functions of the field. (Page 19)

The mental structures and limitations we use are strategies to give the potentially overwhelming world experience some meaning so that we do not become mad. (Page 19)

the Field Theory Perspective is traditionally cultivated within the Gestalt approach and represents something unique (Page 20)

others. Gestalt therapy theory has explored and developed this concept more than most of the other psychotherapeutic approaches (Page 20)

From the Field Theory Perspective the therapist observes the co-creation of the situation here and now. (Page 20)

What was seen as the client’s symptoms from the Psychopathological Perspective or roles from the Contextual Perspective is now understood as co-created by both the client and the therapist. (Page 20)

He transfers his attention from “another time and another place” (Yontef, 1993) to “here and now”. (Page 20)

organised. The therapist observes how he organises himself in the presence of the client; he traces his own here and now responses to his client. (Page 20)

A person can be seen as the ever changing process within relationships. (Page 20)

The process of organising oneself, the “selfing” (Parlett, 1991), has certain regularities that are (Page 20)

specific for each individual. (Page 21)

The Field Theory Perspective of diagnosis also inherently offers the unique healing potential of a therapeutic relationship. (Page 21)

(Note) The field theory perspective: focus on co-creation of creative adjustment here and now • The therapist asks: “How do we co-create the present phenomena of the shared field (seen as “symptoms” from the Psychopathology Perspective) together with the client here and now?” • The therapist explores his own contribution to the clinical situation in which these phenomena appear here and now in the therapy. • The therapist also focuses on the kind of potential present in the therapeutic relationship. • The therapist asks in what way this particular client is unique for him personally. In what way is the therapist himself unique for this particular client? What meaning does this encounter have in their lives? (Page 22). (Page 21).

The Field Theory Perspective of diagnosis maps the patterns of field formation here and now. (Page 22)

(Note) The therapist concentrates on the existing process in the therapeutic relationship. What kind of contact do the client and therapist have? How does the contact proceed? What are its regularities? What patterns of field organisation appear in the client-therapist relationship? Which patterns from the client’s and therapist’s personal histories come to life here? How do they interact and what new possible ways of field organisation might appear? The therapist employs the phenomenological method (Yontef, 1993) (Page 22).

3.3.1. Co-created Gestalt (Page 22)

From the Field Theory Perspective of diagnosing, the therapist applies a paradigm radically different not only from the medical approach, (Page 22)

also from the systemic approach. (Page 22)

The observable phenomena (Page 22)

seen without evaluation as creative adjustment, as functions of the field. (Page 22)

the therapist’s own awareness and interpretations are understood as functions of the field; (Page 22)

arise from the shared situation (Page 22)

The therapist is diagnosing a relationship. (Page 22)

the therapist includes himself in the phenomenological observation. (Page 22)

The therapist asks: “How do the client´s phenomena affect me? How do I contribute to them?” (Page 22)

“Who did I become when meeting this client? (Page 23)

And what kind of person is he with me?”; (Page 23)

“In what kind of story are we taking part together?”; (Page 23)

“What metaphor might I choose to describe our relationship? (Page 23)

Might we be, for example, like a pair of fairy tale creatures or animals? (Page 23)

What are the risks and potentials of such a relationship?”. (Page 23)

The therapist experiences a relationship with him similar to that experienced by people from the client’s surroundings. (Page 23)

contrary, it is crucial that the therapist allows himself to be seduced and pulled into his client’s usual process of field organisation so that he can taste this kind of field process from within, (Page 23)

The therapist co-creates the client’s diagnosis. (Page 23)

There is a danger, though, (Page 23)

He might assess the situation either through projective thinking: (Page 23)

or through retroflective thinking: (Page 23)

There are always both of these poles present: (Page 23)

It is the therapist’s task to observe with curiosity his own awareness within the field he shares with his client. Then he can use himself as a diagnostic tool. (Page 23)

3.3.2. The Non-Expert Approach (Page 24)

from the Field Theory Perspective, (Page 24)

He is aware of his own habitual and safe ways of field organisation, his fixed gestalts, his diagnosis. (Page 24)

that the diagnosis he imputed to the client from the Psychopathology Perspective and Contextual Perspective points, (Page 24)

back to him. (Page 24)

How could he diagnose the particular characteristics of the client if he was not well familiar with them himself? (Page 24)

The diagnosis serves both as glasses and a mirror. (Page 24)

The more the therapist fears the discovery of certain traits in himself (Page 24)

the more vehemently he will seek to diagnose them in his clients. (Page 24)

When diagnosing the client, the therapist inevitably diagnoses the relationship with him as well. (Page 24)

criteria, he puts the following questions: “When I observe the traits of a borderline personality disorder in my client, how do I then feel myself? How do I contribute to this phenomenon? What can I learn from all this about my relationship with the client? And what can I learn about my own process?” (Page 24)

3.3.3. Diagnosing Within A Relationship (Page 25)

The therapist diagnoses within the frame of a relationship. (Page 25)

While diagnosing, the therapist always actively transforms the therapeutic relationship. (Page 25)

When the therapist examines one aspect of the client’s presence in detail, he simultaneously actively transforms the situation at the risk of frightening away the other possible dimensions of the therapeutic relationship. (Page 25)

3.3.4. The Existential And Spiritual Dimension (Page 25)

Stepping out of the expert position (Page 25)

It facilitates the dialogic encounter, (Page 25)

which is (Page 25)

is the “meeting without aiming” (Yontef, 2006). (Page 25)

The existential offer of the therapist towards the client is: “Accept your experience” (Greenberg, 1996). (Page 25)

From the Field Theory Perspective of diagnosis the therapist therefore also contemplates the existential dimension of a relationship. (Page 26)

From the Field Theory Perspective the therapist diagnoses the present processes happening here and now on the contact boundary. (Page 26)

comprehends psychopathology as the pathology of a relationship, as the “suffering of the ‘between’”(Francesetti and Gecele, 2009). (Page 26)

There are some guidelines for adopting the correct therapeutic attitude that arise from the Field Theoretical Perspective of diagnosis: (Page 27)

- I shall notice the moments when I am avoiding contact myself, when I am focused on the problem and do not see Martin as a person I am meeting at the present moment. (Page 27)

- I shall more carefully distinguish when these moments of avoiding intensive contact provide Martin with feelings of safety and support and when such contact is simply comfortable for me (which would signify my own fixed gestalt). (Page 27)

- I shall also focus on capturing moments when Martin arouses my interest as a person, when I am experiencing emotions with him. I might gradually use these moments to establish more personal contact – either through sharing my experience or through authentic interest in his own. (Page 27)

- This is related to another possible path to follow – to see Martin as a person that has now entered my life. I can ask myself: What can I learn from him? In what way do my relationships resemble his? He is ten years older than I and might now be passing through the exact lifetime crisis that yet awaits me in a way. I shall not expose these thoughts to Martin. Nevertheless, they mean a distinct change in my perspective. (Page 27)

- Posing these questions makes Martin a very interesting, inspiring person for me. And through this change in my attitude I transform the stereotyped organisation of the field of relations. (Page 27)


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