Gestalt Therapy in Clinical Practice.jpg



Social Context and Psychotherapy by Giovanni Salonia
in Gestalt Therapy in Clinical Practice: From Psychopathology to the Aesthetics of Contact (Gestalt Therapy Book Series 2) by Gianni Francesetti, Michela Gecele, Jan Roubal, and Leslie Greenberg

Salonia locates personal functioning within one’s larger social existence, including one’s place in history.

He places psychological theories within the history of ideas ... shows how early theory of Gestalt Theory ... emphasizes claims to individuality and personal self-regulation. ... he adroitly notes that now we must attend to self-regulation of relationships ... he suggests we go beyond “basic personality” in a society to a “Basic Relational Model” that the society promotes. ... Salonia places mental health and psychopathology within the relational model. ... “contact competency” differentiates these aspects of personal functioning very well. ...

Chapter 8. Social Context and Psychotherapy

Emile Durkheim (2007) opens up new research horizons with regards to the relationship between individuals and society through his identification of social influences as concurrent causes (Loc: 4,364)

his insight offers a useful starting-point for considering the connections and correlations between cultural contexts and psychotherapies. (Loc: 4,368)

historical nosology reveals the existence of different pathologies in different cultural contexts: (Loc: 4,369)

pathologies brought to light by Freud (Loc: 4,370)

were connected to the historical and social context of the Austro-Hungarian Empire (Loc: 4,371)

new pathologies (narcissism, borderline) are widespread in the post modern era. (Loc: 4,371)

New patients, then, and the re-emergence of familiar pathologies (Loc: 4,373)

correspond to specific cultural changes (Loc: 4,373)

during the last century, not only were there significant changes made to the existing modes of psychotherapy but new ones also emerged. (Loc: 4,374)

the Fifties, for example, (Loc: 4,375)

A new type of human being was appearing on the horizon: one interested in self-fulfilment rather than in the community and to the pronoun “I” rather than the “we”; (Loc: 4,378)

and inclined to “chew” rather than “introject” laws and the pronouncements of authority. (Loc: 4,379)

About twenty years later, other psychoanalysts, having recognised this transition, proposed new theories (Loc: 4,380)

with the objective of bringing the classical psychoanalytical models “up-to-date”. (Loc: 4,381)

Even social psychology becomes aware that each society generates a specific personality model to which every theory of health or pathology needs to be related. (Loc: 4,382)

the relationship between individual-society is a given: it is found at the centre of a vast panorama of theories (Loc: 4,385)

1. The Basic Relationship Model (BRM) as the Key to Understanding the Relationship Between Cultural Contexts and Psychotherapies (Loc: 4,389)

we take relationships (Loc: 4,392)

as the key to understanding the complexity of the relationship between individual and society (Loc: 4,392)

The Basic Relational Model (BRM) (Salonia, 2005a) answers these needs (Loc: 4,395)

based on the idea that any society, in order to respond to its own survival needs, decides who has priority between the individual and society and gives, according to the context, priority to one or the other. (Loc: 4,398)

1.1. The BRM/ Us (Loc: 4,401)

Society’s interests are paramount when there is a period of common fear (caused by war, starvation or epidemics) (Loc: 4,403)

“we” is given precedence, and the model we define as BRM/Us predominates (Loc: 4,407)

very little interest is manifested towards people’s inner lives (Loc: 4,408)

and all the teachers impart is learnt precisely and in a repetitive manner (Loc: 4,409)

The only aspects of subjective experience that can be freely expressed, and seen positively, are those of the leader, of the hero (Loc: 4,410)

The leader (Loc: 4,413)

has absolute power and is thanked when he exercises it clearly, (Loc: 4,414)

is willingly obeyed and much is forgiven (Loc: 4,415)

because he has the destiny of society. (Loc: 4,415)

This BRM/Us model comes to dominate, as we have already said, in situations (Loc: 4,417)

when something new comes into being (Loc: 4,418)

The group becomes “Us” in unity with the leader whose exceptional qualities and acknowlledged (Loc: 4,419)

“We are great and special because our leader is (Loc: 4,420)

there is no room for dialogue, for subjectivity, for the self-exploration of the single individual (Loc: 4,421)

It is not useful to dedicate space to difference (Loc: 4,422)

but it is essential to support convergences (Loc: 4,423)

the “Us” is perceived as the limit that separates us from “Them”, from others seen as enemies or as unimportant: (Loc: 4,424)

The “Us” is created either by the enemy (Loc: 4,426)

or by a narcissistic sense of belonging (Loc: 4,427)

In these social contexts, psychopathologies are characterised by fear in its multifarious forms: a sense of guilt rooted in the fear of separation, phobias or obsessions as fear of feelings and action (Loc: 4,428)

there is a fear of emerging from the community in order to be oneself, to become independent (Loc: 4,429)

1.2. The BRM/I (Loc: 4,432)

When the generalised source of fear (Loc: 4,433)

Is over (Loc: 4,434)

Society-community (Loc: 4,434)

Experiences complexity (Loc: 4,434)

followed by fragmentation (Loc: 4,435)

subjectivity begins to emerge (Loc: 4,435)

progressively manifests the need to legitimise itself (Loc: 4,435)

to attain full self-realisation (Loc: 4,436)

this process occurs slowly (Loc: 4,436)

goes through specific phases (Loc: 4,436)

namely, rebellion, narcissism and (Loc: 4,437)

confusion (Loc: 4,437)

this stage is characterised by the “I” pronoun: BRM/I (Loc: 4,438)

interest for the common good becomes greatly diminished whilst personal points of view are given great importance, (Loc: 4,438)

people are more concerned with their rights than with their duties (Loc: 4,439)

the leader is neither recognised nor accepted, (Loc: 4,440)

People wish to grow without the effort and mistakes involved in learning, and anything that might end in humiliation is avoided. (Loc: 4,440)

Experience – the main expression of subjectivity – becomes the place whe-re learning occurs as well as being the criterion for making judgements. (Loc: 4,443)

Any diversity is legitimised and can be presented to the world without prior ontological evaluation. (Loc: 4,445)

weakening of ties leads to the fragility of social cohabitation (Loc: 4,446)

Much space is dedicated to listening to oneself, both in creative forms of expression (Loc: 4,449)

as well as in that request for help that is called “accompanying” (of therapists or family guidance, of of philosophers or in spiritual matters). (Loc: 4,449)

Unequal relationships are reduced to a minimum. (Loc: 4,452)

it is not a social role which endows authority, but the individual caregiver who has to inspire (Loc: 4,452)

sense of belonging is perceived negatively as representing a limit to individual potential. (Loc: 4,453)

The only places in which an “Us” relationship model is accepted – even if living in a context dominated by BRM/I – are places in which one’s life is at risk: on a plane, in an operating theatre, etc. (Loc: 4,456)

Let us conclude. (Loc: 4,459)

with a recent example which demonstrated once again how it is society which determines the Basic Relational Model. (Loc: 4,460)

in New York in the aftermath of 11 September 2001 noticed that for a long time New Yorkers, like many Westerners, had suddenly rediscovered “Us”. (Loc: 4,460)

People had reverted to thinking in terms of “Us”, of accepting the reduction of their liberties and rights in order to be protected. (Loc: 4,462)

danger had revolutionised relational thought. (Loc: 4,463)

sociologist (Ackerman, 2008) wrote recently that we ought to learn a better way of living unconnected to situations of danger or war. (Loc: 4,463)

Forms of psychopathology in the BRM/I undergo radical reassessment: (Loc: 4,466)

term “psychopathology” (Loc: 4,467)

is called into question (Loc: 4,467)

emphasis is placed on the positive value of illness as a creative choice and survival strategy in situations of extreme danger (Loc: 4,467)

Rather than (Loc: 4,468)

psychopathology (Loc: 4,469)

“malfunctions” or “personal functional styles” are preferred. (Loc: 4,469)

The most basic form of anguish consists in the fear of being suffocated by the community, (Loc: 4,470)

Without experience of strong ties, it becomes difficult to construct one’s identity and both create and maintain significant relationships. Pathologies (Loc: 4,471)

post modern pathologies range from confusion (borderline) to identity crises (panic attacks), to significant relationship phobia (narcissism). Depression, an antique malaise, acquires new significance in BRM/I societies and demands that therapeutic practices be thought through anew. (Loc: 4,473)

2. Social Changes and Developmental Theories (Loc: 4,476)

changes in base relational models (Loc: 4,478)

give rise to (Loc: 4,479)

a different concept of maturity (Loc: 4,479)

I If we look at child development theories of the last century, we realise that there have been changes in them, too; (Loc: 4,481)

they also reach divergent conclusions as to what constitutes (Loc: 4,482)

developmental maturity. (Loc: 4,483)

Freud, the goal of growth was the attainment of the genital phase, (Loc: 4,483)

that is, to love and to work which one reaches by becoming aware (Loc: 4,484)

of one’s instincts (drives) and their repression operated through fear of the Super-ego. (Loc: 4,485)

Maturity is (Loc: 4,486)

seen as a compromise between social factors (and the Super-ego) and those of the individual. (Loc: 4,486)

In the Fifties, Gestalt Therapy conceived of maturity as “creative adaptation” (Loc: 4,488)

to “bite” in order to learn how to combine adaptation (belonging) and creativity (subjectivity) (Loc: 4,488)

Mahler, in the full bloom of a narcissistic society, elaborated an infant development model which emphasised personal freedom in the act of learning to walk (Loc: 4,490)

but as the ability to move away (Loc: 4,492)

and defined maturity as “object constancy” (Loc: 4,492)

Jonathan Livingstone Seagull who leaves the group because he feels special (Bach, 1973) (Loc: 4,493)

In the post-narcissistic period the need to take others into account returns with a vengeance (Loc: 4,495)

Daniel Stern (1987; 1999) proposes a developmental theory connected to the theory of self (Loc: 4,496)

the narrative Self, of the ability to narrate and narrate oneself, to live relationships with others in the triadic dimension of openness. (Loc: 4,497)

he adopts some basic tenets of Gestalt Therapy (Loc: 4,499)

any type of maturity is relational maturity. (Loc: 4,499)

self, in fact, is always and everywhere in relation. (Loc: 4,500)

In Gestalt Therapy developmental theory, maturity is defined as “contact competency” (Loc: 4,500)

New hermeneutics emerge: the Oedipus complex, for example, is no longer seen as a problem for the child, but as the expression of a problem in the couple (Loc: 4,501)

the new anthropological setting, (Loc: 4,502)

which sees males and females both in the home and working outside it, (Loc: 4,502)

a new developmental prospective emerges which considers growth in relation to the declination of the primary triangle and also of co-parenting (Loc: 4,503)

To summarise (Loc: 4,504)

 it would appear that in times of war children are brought up to “take part”, to obey, and to swallow the rules (Loc: 4,505)

in a narcissistic period they are brought up to be independent and to express… Some highlights have been hidden or truncated due to export limits. (Loc: 4,506)

in a narcissistic period they are brought up to be independent and to express their full potential; in a post-narcissistic period, to express themselves within relationships. (Loc: 4,506)

3. Psychotherapies or Psychotherapy? (Loc: 4,509)

can one hold that a clinical model is good for all periods and in every context? (Loc: 4,511)

can clinical models which were created decades ago, in completely different historical and social contexts, still meet the needs of a world which has completely changed? (Loc: 4,511)

For some, the theory and practise of their model has a value which is beyond questions of time or space, (Loc: 4,514)

For others (for instance, DSM IV), objectivity is reached through a descriptive approach to psychopathology, forgetting that every description is an interpretation (Loc: 4,515)

to create integrated models (Loc: 4,516)

is also a way of denying the necessity of continually up-dating any therapeutic model. (Loc: 4,517)

it is precisely the lack of connection between psychotherapy and social context that renders a psychotherapeutic approach weak. (Loc: 4,518)

take the example of psychoanalysis (Loc: 4,519)

a follower of Freud’s who acknowledged (Loc: 4,523)

that we have gone from the Guilty Man to the Tragic Man (Kohut, 1976a) (Loc: 4,524)

the horizon in which Freud’s patients lived was the guilt of not being able to separate themselves (Loc: 4,524)

today’s patients (Loc: 4,525)

(from the last twenty years of the Twentieth century onwards) (Loc: 4,525)

suffer from the tragic lack of a relational identity (Loc: 4,526)

they cannot succeed in feeling part of a community which they perceive as being both “necessary and impossible” (Esposito, 1998). (Loc: 4,526)

Among the approaches which have always deemed the continual process of addressing socio-cultural changes to be an integral and decisive part of their work, we find Gestalt Therapy. (Loc: 4,528)

the epistemology of its experiential-relational model, it makes use of hermeneutics (Sichera, 2001) because, (Loc: 4,529)

tools, it is possible to achieve a process of understanding which includes, in an inevitable and illuminating circularity, (Loc: 4,530)

Text, (Loc: 4,531)

author, (Loc: 4,531)

reader and (Loc: 4,531)

cultural context (Loc: 4,531)

On … one hand (Loc: 4,531)

is, the therapist, the patient and the model (Loc: 4,531)

on the other, the model itself and the context in which it grew out of as well as the context in which it is being applied. (Loc: 4,532)

the socio-cultural contextualisation of understanding psychological malaise (Loc: 4,533)

is an indispensable condition, if not an all-embracing one, of any therapeutic process (Loc: 4,534)

take an example from the history of Gestalt therapy to clarify (Loc: 4,535)

for making the choice in favour of hermeneutics. (Loc: 4,535)

Perls (Loc: 4,536)

synthesised his theory in the so-called “Gestalt prayer” (1980, p. 12) (Loc: 4,536)

«I am I – you are you. I am not in the world to live up to your expectations and you are not in this world to live up to mine. And if by chance, we find each other, it’s beautiful. If not, it can’t be helped». (Loc: 4,537)

the context in which Perls wrote it (Loc: 4,538)

people could not manage to separate themselves from from dysfunctional relationships, (Loc: 4,539)

these affirmations had a therapeutic value. (Loc: 4,539)

in a different context (e.g. in the narcissistic Seventies) they become a non-sense. “Don’t tie yourself” and “Follow your own path” is precisely what people who live their relationships narcissistically are experts at: (Loc: 4,540)

What they find difficulty in doing is quite the opposite, (Loc: 4,541)

another clinical example. Fritz Perls, with great clinical intuition, asked patients who continually asked questions (Loc: 4,543)

to transform their questions into statements: (Loc: 4,544)

in a narcissistic culture, instead, it is opportune to ask patients (who are self-referential and so have difficulty in asking) to turn statements into questions. (Loc: 4,545)

Another (Loc: 4,546)

consideration is that the contextualisation of psychological malaise (Loc: 4,547)

redefines its significance: a person who has a relational model of dependency will attribute a different relevance to his malaise (Loc: 4,547)

in a context in which belonging is highly prized (Loc: 4,549)

or one which rates self-fulfilment more highly (Loc: 4,549)

The Basic Relational Model is (Loc: 4,550)

the first and decisive paradigm for understanding any psychological malaise and, (Loc: 4,551)

for being able to determine the direction the therapeutic process should take. (Loc: 4,551)

4. Gestalt Therapy as Psychotherapeutic Model for the Postmodern Cultural Context (Loc: 4,590)

psychopathology and Freudian treatments are part of the hermeneutics proper to BRM/Us (strong society-weak individual) (Loc: 4,593)

Gestalt Therapy, emerging at the beginning of the BRM/ I, elaborates a novel hermeneutics and a new clinical practice for the treatment of psychological malaise; (Loc: 4,593)

psychological malaise arises “from” and “in” a disturbed relationship, and it shows itself in the inability to form healthy relationships; it is cured “with” and “in” a (therapeutic) relationship. (Loc: 4,597)

GT hermeneutics, the fundamental concept of psychopathology is, in fact, the inability to encounter the other, that is – on a phenomenological level – the fact that a desire (intentionality) for contact is interrupted and does not come to fruition. (Loc: 4,599)

genuine contacts do not occur if one dominates the other or submits to the other but by arriving at the “contact boundary” with an in intact self (Loc: 4,601)

capable of seeing the fullness of the other, too (Loc: 4,602)

Contact (Loc: 4,604)

gives an existential sense of completeness and pleasure. The ability to create nourishing contacts is innate, but it is developed and is sustained (Loc: 4,604)

The ability to create nourishing contacts is innate, but it is developed and is sustained (Loc: 4,604)

by parental figures in the moments in which one learns – at the level of bodily relations – the schemata of being-with (Loc: 4,605)

GT psychotherapy is the description of the various ways in which one fails to reach the other. (Loc: 4,607)

The different types of classic psychopathology or the various styles of malaise (Loc: 4,608)

are distinguishable on the basis of the moment in which the subject, on his way towards nourishing contact in the environment, interrupts his journey. (Loc: 4,609)

gravity of the illness is found (Loc: 4,610)

in the difference between integrity of contact and fullness of the contact. (Loc: 4,611)

In the cipher of relations (Loc: 4,614)

which in GT is central and decisive (Loc: 4,614)

the symptoms and cure of psychopathology are discernable in body-relationship experiences (Loc: 4,614)

GT focalises the relationship between the subject and others in lived relationships (Loc: 4,615)

which, in turn, has an inevitable bodily matrix (Loc: 4,616)

“how I feel with respect to the other” (Loc: 4,616)

the phenomenological matrix of Gestalt Therapy finds it place precisely in this affirmation. (Loc: 4,617)

failure or success of contact intentionality are “visible” in the body or, better, in the body in relation. (Loc: 4,617)

the “inter-body-ness”. (Loc: 4,618)

between the child’s body and the parental figure’s first, and that between the patient and the therapist subsequently, where the fluidity or the interruption of a contact episode is perceived. (Loc: 4,619)

It is from the body that the first slow but significant movements of opening up of words and body come (Loc: 4,620)

Comment by Philip Lichtenberg (Loc: 4,623)

Salonia locates personal functioning within one’s larger social existence, including one’s place in history. (Loc: 4,625)

He places psychological theories within the history of ideas (Loc: 4,627)

shows how early theory of Gestalt Theory (Loc: 4,627)

emphasizes claims to individuality and personal self-regulation. (Loc: 4,628)

he adroitly notes that now we must attend to self-regulation of relationships (Loc: 4,629)

he suggests we go beyond “basic personality” in a society to a “Basic Relational Model” that the society promotes. (Loc: 4,630)

Salonia places mental health and psychopathology within the relational model. (Loc: 4,631)

“contact competency” differentiates these aspects of personal functioning very well. (Loc: 4,631)