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Object Relations in Gestalt Therapy

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The author of Personality Disorders: a Gestalt Therapy Perspective proposes a revision of Perls, Hefferline and Goodman's Theory of the Self in a way that brings it closer to contemporary issues in in the area of Personality Disorders. Understanding splitting and projective identification that chronically lead to experiential impasses, is an essential feature of the psychotherapy of the more severe personality disorders. In order to do so within the Gestalt framework, the author integrates certain developmental concepts fromobject relations theory, especially those put forth by W.R.D. Fairbairn (1954).This revised developmental perspective leads to an Object Relational Gestalt Therapy, in which the here-and-now therapeutic relationship is related to the there-and-then of the developmental past, as well as to the there-and-now of the client's current life situation. This text contains the integral version of the author's doctoral thesis. The thesis as such is followed by chapters on ORGT as Evidence Based Practice, and on the neurodynamics of ORGT. Finally, three cases analyses illustrate the theory in clinical context.

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Chapter One - Fifty Years of Gestalt Therapy

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CHAPTER ONE

Fifty years of Gestalt therapy

After four editions of his book, Maddi (1989) finally includes Gestalt therapy in his comparative analysis of theories of the personality. Even then, he considers it a recent approach and cites only three references to Perls: (1) In and Out of the Garbage Pail (1969), considered by some to be a simple autobiographical essay (Clarckson & Mackewn, 1993; Stoehr, 1994); (2) Gestalt Therapy Verbatim (1969); and (3) Ego, Humor (sic!) and Aggression, which he cites as 1969, although Ego, Hunger and Aggression was published in 1942. One can only conclude that the theory of Gestalt therapy is relatively unknown, if a recognized specialist in the field of theories of the personality fails to cite the fundamental 1951 reference (Gestalt Ttherapy: Excitement and Growth in the Human Personality) and if other important authors (Drapela, 1987; Hall & Lindszey, 1957; Pervin, 1990) completely ignore the approach.

In spite of its limited visibility, Gestalt therapy has made important contributions to clinical thinking and practice (Bergin & Garfield, 1991). The major contribution of Gestalt is the holistic perspective, the idea that the interrelations between objects and persons are such that no situation can be reduced to the simple sum of its parts. Consequently, Gestalt defends the notion, relatively new at that time (Perls, 1942; 1947; Perls, Hefferline & Goodman, 1951) that the real, here-and-now relationship is as important as transference (Clarckson & MacKewn, 1993, p. 87). For Yontef (1993), psychoanalysis, in recent developments, has clearly integrated many elements borrowed from humanistic psychology and Gestalt therapy, including recognition of the importance of the real relationship. Certain ideas developed by Perls and by Perls et al. have certainly been assimilated, whether consciously or unconsciously, by thinkers in the psychodynamic tradition, sometimes even being announced as their own original discoveries (Burgalières, 1992; Miller, 1988, 1991).

 

Chapter Two - Theorising and Knowledge in Psychology

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CHAPTER TWO

Theorising and knowledge in psychology

According to Rennie, Phillips, and Quartaro (1988) there is a growing consensus to the effect that psychology has overestimated methodologically correct research to the detriment of thinking and creativity. As a result, theorising is less respected and known than trivial, busy-work empirical research (Bakan, 1967; Brandt, 1982; Endler, 1984; Gergen, 1982; Secord, 1982). In the same vein, Granger (1994) questions the indiscriminate use of the experimental method in clinical and social psychology, calling instead for an increased use of the potentially richer methods of observation and modelling. It should be pointed out that theorising is in no way easier than research. “(Theorising) demands a considerable effort of concentration, examination, and re-examination. It is the antithesis of casual reflection, lazy reading, and undisciplined speculation” (Gottfredson, 1983). Feyerabend (1975, p. 520) suggests that we all need a good dose of methodological anarchy to help us find new ideas!

 

Chapter Three - Integration in Psychotherapy: Epistemological and Methodological Considerations

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CHAPTER THREE

Integration in psychotherapy: epistemological and methodological considerations

In the first chapter, we saw that several authors had serious reservations about the theoretical foundations of Gestalt therapy. At the end of our review, we shared this critical perception and immediately dissociated ourselves from a defence of the 1951 theory that held that any “limits” found by critics were only a result of a superficial reading of the 1951 work. Monument though it may be, the Perls, Hefferline, and Goodman theory of the Self is not an untouchable museum piece in a glass box (Gagnon, 1993): it needs to be revised and extended (From, 1984, cited by Bouchard & Derome, 1987). Our aim here will be to revise the theory while at the same time respecting its characteristic conceptual structures, to complete it without denaturing it. To this end, we attack the central weakness of the theory, the absence of concepts necessary for an understanding of underlying pathologies, of development, and of individual differences. Gestalt therapy draws its strength from phenomenological roots that have an existential, humanistic colouring. This is the heritage that we must respect.

 

Chapter Four - A Comparative Analysis of the Perls, Hefferline, and Goodman Theory of Self and Fairbairn's Endopsychic Structure in Terms of Greenberg and Mitchell's (1983) Four Fundamental Problems

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CHAPTER FOUR

A comparative analysis of the Perls, Hefferline, and Goodman theory of Self and Fairbairn's endopsychic structure in terms of Greenberg and Mitchell's (1983) four fundamental problems

We can now proceed to address each theory with four fundamental problems, beginning with Perls et al. followed by Fairbairn. A discussion follows, in terms of complementary and/or compatible conceptual relations between the theories, as well as possibilities for their integration.

The basic unit of analysis: what is initially present, what is developed later, what constitutes personality?

Perls, Hefferline, and Goodman

Gestalt therapy defines itself as the science and the applied techniques related to figure-ground relationships in the organism-environment field (Perls, Hefferline & Goodman, 1951, p. 36). Gestalt therapy is rooted in certain neo-psychanalytic theories, as well as Buberian existentialism and the dynamic field psychology of Lewin (Bouchard, 1985; Clarckson and MacKewn, 1993; Stoehr, 1994). The two generally recognized canonical texts of Gestalt therapy take marked exception to Freud's individualist psychology, which sees the Self as derived from the action of drives and where the environment has at best a marginal role. For Perls et al. in fact, any research of a biological, psychological, or sociological nature must necessarily begin by positing an interaction between the organism and the environment.

 

Chapter Five - Epistemological and Methodological Preconditions for a Gestalt Therapeutic System

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CHAPTER FIVE

Epistemological and methodological preconditions for a Gestalt therapeutic system

In the preceding chapter, we analysed the theories of Perls, Hefferline and Goodman (1951) and Fairbairn (1954) with respect to four fundamental questions of Greenberg and Mitchell (1983) and concluded that the compatible and complementary natures of these two theories could indeed facilitate fruitful interactions and integrations.

Both theories share a relatively rare unitary vision of consciousness. For both, contact and relation are the primary realities. Contact zones, be they oral, anal, etc., as in psychoanalysis, or visual, tactile, etc., as in Gestalt, are functions that permit the initiation and development of contacts and relations. In both, the Self is seen as possessing its own energy and oriented toward the real Field from the very beginning.

The two theories, as we have seen, present numerous complementarities, in the sense that an area neglected by one will be developed by the other, in mutually respectful ways. For example, as already noted, Perls et al. are silent on the important question of development, while Fairbairn advances a theory of development based on early interactions with the mother, a theory consistent with Gestalt thinking in that there is a passage from infantile dependence (confluence) to mature dependence (contact within the Field). Again, as we have seen, the Gestalt theory of the organism/environmental Field throws a remarkably clear light on the processes by which the Self interacts with the environment, but neglects the structural aspects of a Self that is considered essentially as a unified spatial-temporal event occurring at the contact boundary. In contrast, Fairbairn focuses on the developmental processes that permit an understanding of the intra-psychic dynamics underlying that interaction. However Fairbairn, in turn, does not elaborate, as do the Gestalt therapists, on the object relation modalities that allow the internal object to persist and regenerate.

 

Chapter Six - The Linear-Sequential Vision of the Self in Perls, Hefferline, and Goodman: A Critique

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CHAPTER SIX

The linear-sequential vision of the Self in Perls, Hefferline, and Goodman: a critique

In Chapter Four, our comparative analysis of Perls et al. and Fairbairn led us to identify certain limits of Gestalt therapy's theory of the Self. In this chapter, we continue this critical analysis, examining some additional shortcomings of the Perls et al. theory of the Self, shortcomings that are a consequence of their strict conception of the Self as a non-structural phenomenon unfolding in time. We will conclude that the Perls et al. conception of the Self, based as it is on a biological foundation, might be adequate for certain simple situations but fails when applied to complex human interactions.

According to Perls et al., three conceptual components are combined in the Self, which (1) is formally defined as a function of contact in the ephemeral present; (2) unfolds according to a strict temporal sequence in the stages of contact, and (3) develops neurotic qualities as a consequence of an inhibition of contact in the present (1951, p. 178).

 

Chapter Seven - The Self and Object Relations: A Revision of Perls, Hefferline, and Goodman

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CHAPTER SEVEN

The Self and object relations: a revision of Perls, Hefferline, and Goodman

After making several detours in order to tidy up diverse epistemological and methodological considerations, we now arrive at the revision of the Gestalt theory of the Self that has been our goal all along. As we have mentioned, it is not our intention to rewrite this theory, but rather to revise it in order to permit a more adequate understanding of the loss of the unity of consciousness and how that loss leads to pathologies of the personality. We will begin by setting forth those elements of Gestalt theory that are worth preserving, and as our revision proceeds, we will present omissions, additions, and modifications of the original Gestalt theory.

The development of the Self and the process of internalisation

At birth, the individual is a unified psychophysiological organism, living in a unified Field. The Self is the psychic apparatus that evolves and becomes differentiated as a consequence of contact with the surrounding human environment. A person is born with cognitive, affective, and sensory-motor capacities that can become actualised through contact with a favourable environment. This environment functions to support the child as it lives through the challenges and obstacles to its development. Human life can be seen as a continuing sequence of to-and-fro movements, of contact and retreat. In other words, the Self is progressively constructed through interactions with the human environment, and the component parts of the Self are, in fact, internalised human relations. These considerations have led us to propose an enlarged vision of the Self in which the Self is seen as more than a spatio-temporal process activated during a contact cycle and that evaporates when that cycle is terminated.

 

Chapter Eight - Gestalt Psychotherapy: From Object Relations to Hermeneutic Dialogue

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CHAPTER EIGHT

Gestalt psychotherapy: from object relations to hermeneutic dialogue

In our revision of the Gestalt theory of human nature, we have attempted to fill in some of the gaps in the original version by incorporating several elements from the endopsychic structural approach of Fairbairn. As we have progressed, it has become clear that both schools see the healthy adult as free from the need for compensatory attachment to internal objects, his or her energy being entirely available for contacts and interactions with other individuals in the environment. This vision of the healthy adult can be considered to constitute the goal of deep psychotherapy, in that the individual with a personality disorder invests an inordinate amount of energy in the introjected microfields, thus limiting his capacity for creative adjustments in the external Field.

In order to arrive at a complete therapeutic system in Mahrer's sense of the term, we need to add a theory of psychotherapy that would be consistent with our theory of human nature. But in the context of our functional-deductive epistemological approach, it would be premature to attempt such a step. As clinical experience progressively validates or eliminates hypotheses, such a theory could develop; in the meantime we will propose a provisional foundation for a Gestalt theory of the psychotherapy of the introjected field—the Gestalt equivalent of object relations—in the context of the treatment of personality disorders. This foundation could serve as a preliminary connection between a revised theory of the Self and a Gestalt clinical practice that remains to be systematically developed. Our aim is not to produce a manual or a guide to clinical psychotherapy, but rather to sketch the boundaries within which, it seems to us, Gestalt psychotherapy should evolve.

 

Chapter Nine - Neuroscientific Perspective of ORGT: Neurodynamics of the Self in Therapeutic Dialogue

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CHAPTER NINE

Neuroscientific perspective of ORGT: neurodynamics of the Self in therapeutic dialogue

Can contemporary neuroscience make substantial contributions to the theory and practice of psychotherapy? New possibilities of observing the brain in vivo have spurred growth of two major axes of research, each of which holds great potential pertinence for psychotherapy. The first addresses the pathogenesis and malleability of certain pathodynamic elements, and asks questions such as: what is the neurodevelopmental history of impulsiveness, shame, the incapacity to remain calm, separation anxiety, and so forth. In fact these questions are not limited to the history of development, but touch as well upon the conditions that can permit these mental states or tendencies to be reversed. The second axis of research addresses the functional mechanisms of psychotherapy such as, for example, the generality and the permanence of the effects of psychotherapy on synaptic function.

Historical background

 

Chapter Ten - ORGT and Evidence-Based Practice

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CHAPTER TEN

ORGT and evidence-based practice

Marc-Simon Drouin, Ph.D. 1

Introduction

Object relation Gestalt therapy (ORGT), as developed in the writings of Gilles Delisle (1998, 2004) has become an influential model of therapeutic intervention, particularly in Quebec and in Europe. In recent years, a large number of therapists have been trained in ORGT, or have at least been introduced to its principal concepts through a series of seminars and didactic activities offered to mental health professionals. ORGT can be defined as a treatment of contact failures within various domains of experience by means of a hermeneutic dialogue: the approach was developed for the treatment of pathological personalities. This rigorous therapeutic model has substantial theoretical support and satisfies Mahrer's (1989) criteria for coherent psychotherapeutic models: a theory of human nature, a theory of psychotherapy, and a set of concrete operational procedures.

Delisle (2008) has shown that recent research in the neurosciences has given some support to the application of the ORGT model in the clinic. But in spite of this non-negligible validation, ORGT, along with several other psychodynamic and humanist models, has remained largely outside the mainstream of evidence-based psychotherapy.

 

Introduction to the Case Studies

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INTRODUCTION TO THE CASE STUDIES

The following case studies were written by clinical psychologists with varying degrees of experience and mastery of the ORGT approach. Michel Dandenault, Ph.D. has been in private practice in Ottawa for twenty years, and recently completed the third level, the highest of the ORGT training program offered by the CIG. Guilhème Pérodeau, Ph.D., is a professor of psychology at the Université du Québec in Outaouais. She also recently completed the third level of the ORGT program and began private practice a few years ago. Finally, Dorothy Scicluna, D.Psy., has been in private practice in Malta for several years. Unlike the other two, she did not complete the clinical training program offered by the CIG, but was introduced to ORGT during an introductory workshop that I gave in Malta in March of 2009. None of the three are native anglophones.

The authors were asked to begin with a general framework featuring a multiaxial diagnosis and a structural diagnosis, as well as a global summary of the psychotherapy conducted in terms of the theory presented here. Apart from these minimal requirements concerning the structure of the presentation, each author was encouraged to express their personal vision, using their own style. The resulting texts were sometimes concretely detailed, sometimes global and abstract. Sometimes the diagnosis was described in detail, while sometimes the author chose to more deeply explore symptom reproduction in psychotherapy.

 

Chapter Eleven - Bob

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CHAPTER ELEVEN

Bob

“I dream of shining as captain of the team, but I end up not being picked”

A case study presented by Michel Dandeneau, PhD, C.Psych.1

He slowly walked into my office with the trace of a smile thinly veiling a shy and gloomy demeanour. He discretely scanned the environment as he waited to be asked to take a seat. He was well-groomed, polite and very cooperative during the interview, expressing little feeling until he talked about his marriage and his work: then distress choked him up and seeped through teary eyes. I was touched by this man who came across as a young boy struggling with his grief.

Bob was referred to me by a psychologist working in his organisation. He was particularly distressed about his marital relationship and complained of feeling frustrated with his lack of promotion at work. Although he had no plans to end his life, he felt depressed with recurrent thoughts of death.

When I met Bob for his first consultation, he was in his mid thirties, held a university degree, and worked in a large government organisation in a low management position. He was married with two young children. At the time of writing, I have seen Bob in my private practice for close to five years. With a few exceptions, he has come in for weekly sessions.

 

Chapter Twelve - Brian

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CHAPTER TWELVE

Brian

Case study presented by Guilhème Pérodeau, Ph.D.1

Identification

Brian (pseudonym) is a man forty-one years old at the onset of therapy. He was born, raised, and still resides in a small rural area in the province of Quebec (Canada), and has cohabited for the last fifteen years with Sheila who manages a small gift shop in town. They have a twelve-year-old son, Maxime, who was diagnosed with cancer at age six, but who has been in remission for the last five years. Brian worked as a plumber at his family-owned business until the time of his motorcycle accident. Following the accident he had his right leg amputated at the knee (he now has an artificial leg), suffered a traumatic brain injury, and had to quit his job.

Clinical context

Therapy took place in a private practice setting over a two-year period. Brian was seen weekly (during the first nine months), then bi-monthly (for the next twelve months) and finally on a monthly basis (for the last three months). He came regularly and cancelled only seven times due to illness, medical examination, or transportation difficulties (during the winter). Costs for the sessions were covered by the Société de l'Assurance Automobile du Québec or SAAQ (Quebec Automobile Insurance Corporation), which provides insurance for personal injuries following road accidents. The SAAQ is responsible for evaluation, treatment, and financial compensation in such cases. Brian was assigned a caseworker to whom we sent progress reports on demand.

 

Chapter Thirteen - Jade

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CHAPTER THIRTEEN

Jade

A case study presented by Dorothy Scicluna 1

Jade came to psychotherapy unaware of her non-embodied self. Throughout her journey she retrieved most aspects of herself, became aware of her views of Self and Others, and has figured out that she deserves to be happy.

Anamnesis

Jade calls for an appointment. She says that she was referred by an ex-client of mine. This is October 2008. I see her in private practice. She comes for her first session and she reminds me of a diligent school girl. Dark curly brown hair pulled back in a pony tail, no trace of makeup, rosy freckled cheeks, fair skin, small features, and dark blue eyes. She wears dark clothes. She will keep regular Friday appointments. She is a teacher in a secondary school reputed to be a difficult school. She says she has no trouble controlling the students.

The first session will feel like a warm session and that will be the last of its kind before a long time. At the time of writing this part of the report it is August 2009 and some warm sessions have reoccurred. I must admit, holding Jade during her therapeutic journey was a struggle.

 

Appendix

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Appendix

Structural analysis of the self (Based on the Revised theory of the Self. Delisle, 1995–1998)

A. Function/structure of the Self

Configuration of MFR

What seem to be the nature of Self- and Other-representations?

B. Inferences concerning the I.F.

Inferential hypotheses concerning the presence of Introjected Microfields in the background of the Id, taking into account your observations of the Ego function and the MFR.

 

Reflections on therapeutic process (adapted from Delisle, 1995–1998, CIG, Montréal)

1. Essentially, what is my experience with this client?

2. Can I find some thematic affinities between my experience with the client and some of what he/she reports as occuring in field 3

3. Can I find some thematic affinities between my experience with the client and some of what he/she reports as having occured in field 4?

4. How could I express this construction of meaning in hermeneutic terms?

a partial hypothesis…
that does not exhaust the entire meaning of the phenomenon…
that stimulates the clients' own constructive creativity…
and that keeps affect alive…

 

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