Clinical Psychology, Cognitive Behavioral Psychology
& Gestalt Psychotherapy
Clinical Psychology, Cognitive Behavioral Psychology
& Gestalt Psychotherapy
Once in a while I will meet a client who will ask me "But what should I do?"
It makes sense that people who are struggling, hurting, or experiencing despair would want someone to tell them what to do to make it stop. And the thing that makes it more difficult is that, often, I would like to help them make it stop too, so there is a strong pull to give an answer.
But psychotherapy isn't giving advice.
Therapy is a place to feel safe and accepted, to realize that you are good enough as you are. Remember:
'change occurs when one becomes what he is, not when he tries to become what he is not.'
Therapy a place to gain a better understanding of yourself and your relationships. It's a process rather than an end result and you come to therapy to learn how to do that. It’s what mental health professionals go to school to learn how to provide. Giving advise would be the easy thing to do; but think of this: would someone having a panic attack feel better if you told them they need to calm down? If you are feeling angry, does it help when someone tells you you are over reacting? No.
What helps is to feel seen and heard, taken seriously, having someone opposite to you that can be with you through your worst fear.
Sometimes it takes time and reflection to see the patterns and it isn’t a quick fix, as much as both therapist and client sometimes wish it were. Sometimes just acknowledging and sitting with that pain, confusion, and wish for an immediate answer is the best thing we can do. Because it is what it is, and just like a feeling of anxiety the more you wish it away the stronger it becomes.
This does not mean that a therapist withholds information from clients when they think it might be helpful. If I notice a theme or have some concern that a client may not be acting in their best interest, I speak up. It also doesn’t mean that therapists are non-directive. There are times when I get very directive with clients, if I think that it is in their best interest.
I will bring your attention to patterns in your behavior, to your body and breathing; We will use techinques and excercises, I will keep bringing you back to what you need and what you feel, but the bottom line is that you are the only one that has the answers- I am showing the way to them. We share the work and we share the responsibility, you learn from me and together we discover who you are.
Specific treatment approaches to specific problems are not the same thing as telling a client what to do with major life decisions. If you want a therapist to tell you what to do, as opposed to helping you figure out what is right for you, it could be worth thinking twice about what you’re seeking.
Some people want others to tell them what to do because it means not having to take responsibility if things don’t work out. Friends and counselors can give you advice. But if what you are looking for is just someone to give advice or tell you the things that have worked for them, it may not be psychotherapy that you’re looking for.
A clear limit setting that is age appropriate and in accordance to the situation is essential when working with children. When a boundary is not available the child feels anxious because there is no clear situation to which they can creatively adjust. By setting boundaries we provide a healthy example for the child on how to set their own boundaries thus defining themselves.
Setting boundaries provides the child with a frame of reference on what can and cannot be done, which in turn makes the child feel safe. In a safe environment the child can slowly start to test the boundaries; in that stretch zone, learning is now feasible.
But what is ok and what is not? It is not easy to define right and wrong, andit can prove difficult to be consistent. There are three kind of boundaries to use as a compass(van den Heuvel & Haest, 2015).
These boundaries “are the same for everybody, and are not depended on our perception.
They apply in situations where crossing them has a clear consequence which is potentially life threatening, and has not been decided by another person but is like this by nature.” (van den Heuvel & Haest, 2015)
For example, putting on your seatbelt when you are in a car, drinking water after a long time running outside, not running with scissors in your hands, not eating sand, not touching the stove when it is warm.
All these are explainable but non-negotiable. The key here is to explain the consequence (i.e. If you run with scissors you might hurt yourself or somebody else), without scaring the child.
These refer to “written and unwritten rules within a society; boundaries that are set by other people and are the norm, meaning that they are accepted and respected by the general population. They can depend on one’s culture or family and are there to ensure mutual respect and prosperity amongst people living in a society. Discovering them is a social process.” (van den Heuvel & Haest, 2015)
The normative boundaries in children primarily derive from their family.
However, for expatriate children that live with two cultures at home, and come across a different culture at school and outside school (i.e. French school in The Hague), these are not so clearly defined; what the parents do is not always what is done outside the family, which can be confronting and confusing for the child.
It is important that the child understands that the boundary is concerning a specific behaviour and is not a reflection on what he/she is as a person.
Long suggests that “imaginative abilities are developed and a strong interest for experience and exploration occurs. If [parental] support for these areas of growth is experienced as punitive by the child, feelings of guilt and anxiety occur.” (Long, 2010)
To avoid punitive behaviour, one must repeatedly define the situation within which these boundaries apply.
In van den Heuvel & Haest (2015) relational boundaries are set
“because I don’t want, because I am scared, because I am not in the mood”.
Current belief tends to regard the above as something that should not be included in the relationship; it is the stereotype of the allknowing- almighty adult.
However, by avoiding this children will not learn to create a relationship between equals since they never get acquainted with the other person’s needs.
They will later not be able to imagine a world where there are other needs besides theirs.
On the other pole, making a child feel responsible for your feelings will create guilt and shame, leaving the child uncertain. Actions have reactions, but nobody is responsible for somebody else’s feelings.
Boundaries and Education
In education ever more so than in a family setting, teachers are very hesitant with working on relational boundaries, because they want to maintain their professional status. They then resort to masking them into factual or normative boundaries. The problem is here that children intuitively know that there is something not right, and they keep insisting; we now have a situation of a child “not listening to the teacher”, because the child is not convinced by the teacher’s explanation.
When working with children however, there should be no consequences on the relational boundary: It should never be implied that “I will not like you/ love you/ take care for you” if you do something that is not ok. The key here is again to ensure that the child does not take the consequence as a comment on his/her personality, but rather as an outcome of one behaviour and a learning point.
This is a full video of Fritz Pearls'session with Gloria.
Gloria is a real person, not an actress, and in this (oh so cult) film "Three approaches to psychotherapy" from 1965, she has three sessions with three different therapists in a single day. The other two therapists besides Pearls (Gestalt Therapy), are Carl Rogers and Albert Ellis.
Skip the theoretical intro to get to the actual session.
"Principally I consider any interpretation to be a therapeutic mistake; in this way we imply that the therapist understands the patient better than the patient himself. That takes away from the patient a chance of discovering himself by himself and preventing him from finding out his own values."
This is a question I get asked very often, what is the difference between a psychologist and a psychiatrist?
Bare with me while I attempt to describe the differences in education and application.
First of all, a psychiatrist is a medical doctor. Psychiatrists are trained in general medicine. After earning an MD, they practice four years of residency training in psychiatry. Their experience typically involves working in the psychiatric unit of a hospital with a variety of patients, from children and adolescents with behavior disorders to adults with severe cases of mental illness.
"Psychiatrists are physicians who specialize in psychiatry."
For a psychologist, degrees are available at all levels (bachelor’s, master’s, or doctorate). Advanced degrees and licensing are required for those who offer patient care, including clinical, counseling and school psychologists. Throughout their education, psychologists study personality development, the history of psychological problems and the science of psychological research. Graduate school provides rigorous preparation for a career in psychology by teaching students how to diagnose mental and emotional disorders in varying situations.
"A psychologist is a social scientist who is trained to study human behavior and mental processes."
There are many different kinds of psychologists, and clinical or counseling psychologists are two of them. Clinical psychology is a psychological specialty that is concerned with the assessment and treatment of mental illness and behavioral problems for individuals and families, while Counseling psychology focuses on how people function both personally and in their relationships. Typically psychologists are described as being applied or research oriented.
A therapist is someone that specializes in a specific kind of therapy, for example psychoanalysis, Gestalt therapy, systemic therapy, EMDR therapy or cognitive behavioral therapy. A requirement for becoming a certified therapist is having a high level University degree on a relevant subject, such as psychology, psychiatry or social work. It is a post- graduate specialization in a specific form of therapy that typically lasts three to four years, containing intensive personal therapy, supervision and intervision, seeing clients and requiring theoretical and practical knowledge.
For Europe, there is the European Association of Psychotherapy, which represents high training standards for a scientifically based and independent practice of psychotherapy. Make sure that your Therapist was trained in an institution that was EAP accredited.
A coach or "life coach", generally only has a brief training of 6 months or a year and typically works with clients on improving their life skills, such as weight loss or career change, but they are not credentialed to treat mental health or relationship challenges. These days, almost any body can call themselves a coach, so it is important to see if your coach is accredited by the International Coach Federation or a similar recognized association.
If they do, take the time to look into what kind of therapy they do and if it suits your personal style. And don;t worry, when you first visit a psychologist, he or she will refer you to a psychiatrist if they believe you could be aided by medication. They are qualified to know when that is needed.
Finding the right person to help you is important, and when it comes to your mental health you want to make sure you are in good hands.
No one ever hears a friend say “I have a doctor’s appointment” and immediately thinks that they must be rich/ weak/ crazy. It’s generally the right and less stubborn thing to see a professional when our body is injured or in pain.
But if someone wants to see a mental health therapist, people tend to be more critical.
I talk very openly about the fact that I see a therapist. While my friends and family are supportive, they, along with the general population, still ask questions or make comments that remind me that going to therapy is still not normalized.
Here are some of the most common myths about psychotherapy:
Nothing is farther from the truth!People of all ages need others to lean on at times. We all need to be seen and known deeply by another. We often need a different perspective on ourselves and our situation. Thinking that you can handle everything in life by yourself is, itself, a kind of craziness.
If you go to psychotherapy seeking instructions on how to live your life, you will be disappointed.
Some types of therapy are more directive than others, and approaches such as Cognitive Behavioral Therapy can be extremely prescriptive in the way they tackle problematic thoughts and behaviors.
But psychotherapy is not an advice service. Any mystique is quickly and disappointingly shattered when you realize your psychotherapist is just another human being, albeit with attuned awareness of themselves and others, and a knowledge of particular theories.
" There’s nothing magical about psychotherapy beyond the astonishing capacity of human relationships to be healing. "
Therapy often is expensive. It is a question of budgeting and prioritizing. Some private practice therapists have sliding scale fees for people who truly need financial help to stay in therapy. Most communities have public and private agencies that provide mental health services for a reduced fee. Sometimes, people who are not certain about entering therapy or about prioritizing their own well-being let the cost of therapy be an excuse for not getting help
If you want to start seeing me but you think you cannot afford it, please get in touch and we can agree on a fee that you feel more comfortable with.
This is simply not true: our neuroscience is molded by our early relationships and throughout life our relationships have the capacity to heal just as much as they do to destroy.
Bessel Van Der Kolk reminds us of how “being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives”.
This isn’t just the case for the ‘mentally ill’ or traumatized, but is a universal human need, and one that psychotherapy can go some way to meeting.
To quote Jung,
"Until you call the unconscious conscious it will direct your life and you will call it fate."
Today I received an angry Facebook message:
"you seem to think everybody needs therapy, how charming. You are the one that needs therapy!"
So, apparently, needing a therapist is an insult?
Weirdly enough, on checking my protester's page, I discovered he was pro-meditation and into Zen. And that got me thinking,
Would anybody say "you need meditation" to insult you?
Why is meditation for everybody, but therapy only for the mentally distressed?
Why is psychotherapy and mental health still such a taboo?
A week ago, a lady approached me and angrily asked me why should she go to the therapist and not to a priest. I very much enjoyed having my first talk around my job in Dutch (yay me!), but other than that, I wondered,
why do people have such a strong negative reaction to the idea of psychotherapy?
I think that there is unfortunately very little awareness about what a therapist does and what should one expect to get out of therapy.
"There's the idea that you have to be a little mad, or harbor some huge and strange problem to go and see a therapist. It can be hard to see that therapy isn't in fact for the select disturbed few, it's for everyone. Because actually it's entirely ordinary to be rather confused, a bit anxious, and, sometimes challenged by relationships, family life, and the direction of your career.
So really, the only qualification for going to therapy is to be a normal human being
I came across this amazing video which sums it all up in a lovely way,
please do take a few minutes to watch and feel free to contact me for a chat on the subject, or just leave any comments bellow:
I was first introduced to Gestalt in 2013. As a Clinical Psychologist, I was taught to use rationale, psychometric tests, psychological evaluation techniques and diagnostic criteria. As a Gestalt therapist, I was taught to truly listen, really care, really be there for my clients; there is nothing more healing than someone standing by you.
Those undertaking gestalt therapy will explore their thoughts, feelings, behaviors, beliefs and values to develop awareness of how they present themselves and respond to events in their environment. This gives them the opportunity to identify choices, patterns of behavior and obstacles that are impacting their health and well-being, and preventing them from reaching their full potential.
Gestalt therapy recognizes that forcing a person to change paradoxically results in further distress and fragmentation. Rather, change results from acceptance of what is. Thus, therapy sessions focus on helping people learn to become more self-aware and to accept and trust in their feelings and experiences to alleviate distress.
Together, the therapist and the person in therapy will evaluate what is happening now and what is needed as a result. Therapists refrain from interpreting events, focusing only on the immediate, including the physical responses of the client. The focus on the here and now does not negate or reduce past events or future possibilities; in fact, the past is intricately linked to one’s present experience. The idea is to avoid dwelling on the past or anxiously anticipating the future.
Remarking on subtle shifts in posture, for example, can bring a person into the present. In this way, gestalt therapy helps people gain a better understanding of how their emotional and physical bodies are connected. Understanding the internal self is the key to understanding actions, reactions, and behaviors. Gestalt therapy helps people take the first steps into this awareness so that they can acknowledge and accept these patterns.
"Fundamentally, gestalt therapy works by letting clients learn how to define what is truly being experienced rather than what is merely an interpretation of the events. "
Throughout therapy, a gestalt therapist will concentrate on body language, which is considered a subtle indicator of intense emotions. When specific body language is noticed, the therapist may ask the client to exaggerate these movements or behaviours. This is thought to intensify the emotion attached to the behaviour and highlight an inner meaning. For example, a client may be showing signs of clenched fists or frowning, to which the therapist may ask something along the lines of: "What are you saying with this movement?"
The unfolding of this therapeutic process will typically involve a range of expressive techniques and creative experiments developed collaboratively between therapist and client.
One of the unaddressed elements of children’s behavior is the pain that families go through, knowing that others are judging them. Because the fact is, they are being judged.
Parents feel ashamed of themselves and sense that the cold, unforgiving eyes of the world are upon them, casting judgment on their parenting skills.
“The worst mistake parents make is giving power to public or family criticism over their decision-making about their child.”
It’s natural for parents to get angry at the child when behavior problems are ongoing, but often that anger is triggered by the shame parents feel regarding what other people think about how they parent. If the kid is acting this badly, they reason that it must be a direct reflection on them.
The sad thing is, parents are so focused on their children doing well and keeping out of trouble that they rarely address the fact that the behavior problem is embarrassing for them and they’re having a hard time with it. I think it’s important for parents to acknowledge that to themselves, and it’s important for them to know where to turn to get help without being judged.
Grandparents and Extended Family Members Are Not Therapists
With many kids who act out, the behavior is a long-standing pattern, and the families of the parents have long ago registered their vote on what the problem is. They’ll say everything from "You’re too harsh" to "You’re too weak." "You’re too permissive" to "You’re too strict." "You don’t listen to him." "You need to give him more ‘structure.’"
That’s a common refrain from grandparents that immediately makes the parents feel as if there’s something wrong with them.
Grandparents, aunts and uncles may have a lot of suggestions that are very well-intentioned, but they may not be effective in helping the parent.
I’ve seen many cases where other family members disagree with the parents’ approach and talk about it with the children, and it makes the problem worse.
School: Leave Your Emotions in the Parking Lot
When parents are struggling to manage behavioral problems and their own embarrassment around those problems, they tend to get angry at teachers and school administrators. It’s completely natural. The problem is that getting angry at all those parties doesn’t help change the situation. So if the school calls you up consistently for problems, it doesn’t help to fight with the school. You may want to, but it doesn’t help.
It’s also important to know where the school can help you and where they can’t. The school is not the best source of objective feedback on your child and on your parenting skills because, unfortunately, well-meaning educators and school administrators can either purposely or by innuendo hold the parent responsible for the child’s behavior. That’s going to feel like blame when you are struggling with your child’s problem, and it will only add more shame to what you are already experiencing.
Seek support elsewhere when you feel the school staff isn’t being helpful.
Don’t Let Embarrassment Cloud Your Thinking
Because of their embarrassment and shame, I think parents tend to make errors in judgment, and they respond ineffectively to their kids. One of the things that happens is that parents compare their insides to other people’s outsides. In their gut they feel humiliated, embarrassed, and have a lot of self-doubt. What am I doing wrong? They’re afraid for their child.
Here’s the straight truth: Every family has problems.
Many of them have to do with kids. Some of them have to do with integrity of the adults. Some of them have to do with inappropriate behavior by the adults. Some of them have to do with finances. Some of them have to do with parental conflicts. Some of them have to do with kids’ physical difficulties. But every family’s got problems.
If parents are uncertain about how to handle their kid’s behavior problems, they shouldn’t try to “keep it in the family.” Nor should they rely on the school to fix problems they are not equipped to solve. They should get help outside of the family and the school.
A Word about Hopelessness
After years of feeling held hostage by the problem, and feeling that the system has let them down, parents can feel powerless, and when they feel powerless, they lose hope. Hopelessness breeds skepticism and slams the door on change.
If this is your situation, the message I have for you is that you have to keep trying, because your child is your greatest love and creation. If he’s not doing well, you need to try something different. If you’re going to somebody’s office and not getting help, go to another resource, or, better yet, bring the training into your home where the behavior problems are happening. Doing this could be the one different thing that opens the door to change in your child.
This was written as part of my paper "The good enough Teacher", for the Dutch Institute of Gestalt. It is a paper on implementing Gestalt therapy principles when working with children as an educator.
A child will never ‘listen’ to you, if they don’t have a relationship with you. Therefore, assuming authority and setting boundaries becomes impossible; that is when many educators and parents resort to guilt and shaming as a means to make a child “behave”, with disastrous effects on the relationship.
In Gestalt therapy, building on the relationship is directly related to making contact. In reality, making contact is constant.
Therein lies the equality- the adult can preserve authority thus providing safety, but organizes the ground for true growth by not assuming a position of power. What is fascinating when working with children is that they are much more open to a dialogical relationship than most adults. They have less introjections than adults (simply because they have had less time), so they react to the environment in a more intuitive way. They will let you know what they need, what they like and what they don’t; they are less retroflective and more reactive.
Adults need to be in control in order to alleviate the weight of feeling powerless in the face of being responsible for a human being. In its essence this is no different than a therapist hiding behind his all-knowing mask, for fear of failing; A Gestalt therapist has the tools to accept the powerlessness through awareness and trust in the relationship and in the process.
“I am as authentic as I know how to be-I am myself. I do not use a teacher voice or a patronizing voice. I will not manipulate or judge. Although I am perpetually optimistic regarding the healthy potential of the child I meet in my office, I will not place expectations on her. I will accept her as she is. I will respect her rhythm and will attempt to join her in that rhythm; I will be present and contactful. In this way our relationship flourishes.” (Oaklander, 1997)
Children provide us with infinite possibilities; playing, drawing, hugging, holding hands, singing… Really an infinite number of things that one can do with a child to truly connect. “Far more than just the frivolous, light-hearted, pleasurable activity that adults usually make of it, play also serves as a language for children - a symbolism that substitutes for words. Children experience much in life they find difficult to express in language, and so they use play to formulate and assimilate what they experience.” (Oaklander, 2001)