From: Gestalt Therapy in Clinical Practice: From Psychopathology to the Aesthetics of Contact (Gestalt Therapy Book Series 2). Gianni Francesetti, Michela Gecele, Jan Roubal, and Leslie Greenberg
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Dependent Behaviors
in Gestalt Therapy in Clinical Practice: From Psychopathology to the Aesthetics of Contact. (Gestalt Therapy Book Series 2)
Gianni Francesetti, Michela Gecele, Jan Roubal, and Leslie Greenberg
Loc: 8,703 | 19. Dependent Behaviors |
Loc: 8,704 | by Philip Brownell and Peter Schulthess |
Loc: 8,715 | Gestalt Therapy, stated that the classification, description, and analysis of the structures of the self are the subject matter of phenomenology. |
Loc: 8,716 | the experience of self |
Loc: 8,717 | deserves a phenomenological scaffold |
Loc: 8,717 | to hang the features of dependence, |
Loc: 8,718 | addictive and self-medicating process. This chapter |
Loc: 8,719 | provides a Gestalt therapy orientation to the “what” and “how” of dependent behavior and |
Loc: 8,720 | treatment, |
Loc: 8,723 | 1. Definitions and Diagnoses |
Loc: 8,725 | An orientation to the subject helps |
Loc: 8,727 | descriptions of phenomenological constructs relevant to addiction and recovery. |
Loc: 8,729 | 1.1. Tolerance |
Loc: 8,731 | refers to the need for ever-increasing amounts of a substance to achieve the desired effect or to bring about intoxication. |
Loc: 8,735 | 1.2. Withdrawal |
Loc: 8,736 | physical symptoms resulting from a decrease in the amount of substance in a person’s system. |
Loc: 8,740 | 1.3. Recovery |
Loc: 8,742 | overcoming or healing |
Loc: 8,744 | following an organized program designed to combat the addiction and the tendencies for relapse, |
Loc: 8,747 | 1.4. Co-dependence |
Loc: 8,749 | a disease of lost selfhood» |
Loc: 8,749 | being affected by another person’s behavior to the point that one attempts to control that behavior, |
Loc: 8,750 | co-dependency is a learned behavior associated with an excessive focus on the needs of others |
Loc: 8,751 | the attempt to take responsibility for |
Loc: 8,752 | other people, |
Loc: 8,752 | motivated by the need for safety, acceptance and self-worth. |
Loc: 8,775 | 1.6. Abstinence and Harm Reduction |
Loc: 8,776 | two significant approaches to recovery |
Loc: 8,777 | abstinence and harm reduction. |
Loc: 8,778 | the goal of abstinence is complete sobriety |
Loc: 8,778 | the goal of harm reduction is to modify in some positive direction the dynamic of addictive and self-medicating behavior. |
Loc: 8,784 | have worked myself in both approaches and have seen that both are practised with good effect. |
Loc: 8,788 | 1.7. Phenomenological Concepts Relevant to Dependence and Recovery |
Loc: 8,793 | 1.7.1. Attitude |
Loc: 8,795 | Attitude is related to interest. |
Loc: 8,799 | attitude is the atmosphere we breathe; |
Loc: 8,800 | attitude organizes |
Loc: 8,800 | according to a central interest |
Loc: 8,802 | 1.7.2. Horizon |
Loc: 8,804 | Horizon is related to potential: |
Loc: 8,804 | can be thought of as all things held possible for a given world, |
Loc: 8,805 | When one’s horizon is closed, not much is believed to be possible, |
Loc: 8,808 | 1.7.3. World/Life World |
Loc: 8,810 | World is related to context. |
Loc: 8,812 | It’s our physical neighborhood – but more |
Loc: 8,812 | it’s the mindscape we inhabit. |
Loc: 8,849 | 3. Gestalt Therapy Case Conceptualization and Theory of Dependence |
Loc: 8,851 | various writers have described a Gestalt therapy approach to addiction/dependence |
Loc: 8,852 | there is no explicitly direct treatment of dependent process in Gestalt Therapy. |
Loc: 8,855 | Gestalt |
Loc: 8,855 | speaks about persons in addictive processes instead of addicted persons. |
Loc: 8,856 | this terminology |
Loc: 8,856 | avoids labelling persons with fixed diagnoses. |
Loc: 8,857 | Hans Peter Dreitzel |
Loc: 8,857 | characterises addictive processes as behaviors dependent on certain substances or fixed behavioral patterns. |
Loc: 8,858 | basic |
Loc: 8,858 | introject is: “I can’t stand life without my drug” |
Loc: 8,860 | addictive behavior is not always connected to substances. |
Loc: 8,862 | certain patterns of behavior that are developed in an addicted way |
Loc: 8,862 | e.g. excessive eating, working, gambling, sexual activities, internet-computing |
Loc: 8,865 | 3.1. Field Dynamics |
Loc: 8,880 | Dependence, and the symptoms of addiction, |
Loc: 8,880 | never a simple matter of the individual addict, |
Loc: 8,881 | many times starts as a social and recreational activity carried out with others, |
Loc: 8,882 | is fostered and supported |
Loc: 8,883 | becomes a fixed pattern of contacting within an increasingly shrunken world. |
Loc: 8,883 | dependence is a field phenomenon involving people in groups and dyads |
Loc: 8,884 | also related to the developmental history |
Loc: 8,885 | have to deal with the developmental processes |
Loc: 8,886 | People who develop addictions often grow up |
Loc: 8,887 | where self-medicating is an element in |
Loc: 8,887 | early coping strategy. |
Loc: 8,888 | While it is necessary to understand the individual characteristics of subjective experience, |
Loc: 8,889 | also necessary to grasp the intersubjective and field dynamics that are crucial to treatment and recovery |
Loc: 8,892 | 3.2. Intersubjective, Dyadic Relationship |
Loc: 8,893 | There is a non-independent dynamic in dyadic processes. |
Loc: 8,894 | Kenny, Kashy and Cook (2006) |
Loc: 8,898 | In general, a dyadic measurement reflects the contributions of two persons, although the function of those contributions can be quite different” (pp. 1-2). |
Loc8,898 | Kenny, Kashy and Cook (2006)Kenny D., Kashy D. and Cook W. (2006), Dyadic data analysis, The Guilford Press, New York, NY. |
Loc: 8,901 | Gestalt therapists have been saying as much for decades, |
Loc: 8,902 | such non-independence as intersubjectivity, using Martin Buber’s relational philosophy as a heuristic. |
Loc: 8,902 | people can relate to one another with an I-Thou or an I-It attitude. |
Loc: 8,905 | I-It is the dominant attitude involved in dependent process. |
Loc: 8,907 | people are pawns in |
Loc: 8,907 | self-medicating behaviors. |
Loc: 8,907 | The primary relationship becomes the substance or behavior |
Loc: 8,908 | people become the secondary relationship |
Loc: 8,908 | in co-dependent behavior there is a give-to-get dynamic that makes the security of the relationship the target |
Loc: 8,909 | not intimacy with the other |
Loc: 8,910 | Introduction into substance use often takes place in relationships. |
Loc: 8,913 | these relationships |
Loc: 8,914 | comprise characteristics of friendship, kinship, and partnership in dyads within such groups. |
Loc: 8,926 | 3.3. Subjective, Phenomenal Experience Addictive experience is the retreat from novel stimuli, |
Loc: 8,928 | a desire for repetition of previous experience |
Loc: 8,929 | It is a fixed Gestalt. |
Loc: 8,929 | there is a delusional character to dependence. |
Loc: 8,931 | from a Gestalt perspective. |
Loc: 8,932 | the appetite is usually vague |
Loc: 8.932 | «until it finds some object to work on; it is the work of creative adjustment that heightens awareness of what one wants. But in cases of extreme need, extreme physiological deficit or surfeit, the spontaneous appetite may make itself definite, bright, and sharply delineated to the point of hallucination. In the defect of an object it makes an object, largely out of the fragments of memory. (This occurs, of course, in the neurotic “repetition”, when the need is so overpowering in its influence and the means of approach are so archaic and irrelevant than an ordinary creative adjustment, assimilating a real novelty, is impossible.)» (p. 404). PHG |
Loc: 8,933 | in cases of extreme need, |
Loc: 8,933 | spontaneous appetite may make itself definite, bright, and sharply delineated |
Loc: 8,934 | point of hallucination. |
Loc: 8,934 | it makes an object, largely out of the fragments of memory. |
Loc: 8,937 | This is the spike |
Loc: 8,937 | in Michael Clemmens’ (1997) depiction of the addict’s cycle of experience. |
Loc: 8,939 | the addict goes from sensation, |
Loc: 8,940 | and |
Loc: 8,940 | “hallucinates”, or substitutes an old and fixed Gestalt |
Loc: 8,941 | and goes straight to action. |
Loc: 8,942 | It is the substituting of a previous figure, |
Loc: 8,943 | in the current field |
Loc: 8,943 | and what Gestalt Therapy referred to as a neurotic hallucination. |
Loc: 8,944 | it does not provide anything new |
Loc: 8,944 | there is no learning from experience. There is simply repetition. |
Loc: 8,945 | The attitude becomes increasingly |
Loc: 8,946 | self-medicating interest. |
Loc: 8,946 | horizon loses options of possibility for other behaviors or solutions |
Loc: 8,956 | Another way of looking at this is that the person, |
Loc: 8,956 | is not growing. |
Loc: 8,958 | An organism preserves itself only by growing. |
Loc: 8,962 | This is ego functioning, |
Loc: 8,963 | specifically, this is the organism identifying figures of interest and choosing to move toward them, to satisfy them. |
Loc: 8,963 | in contrast to the id function in which the addict is stuck. |
Loc: 8,964 | the id’s contents are “hallucinatory and the body looms large” |
Loc: 8,965 | there is vague awareness of sensory data, |
Loc: 8,965 | person does not truly pay attention to that |
Loc: 8,967 | There is sensation and neurotic anxiety. |
Loc: 8,968 | a pseudo choice and a delusional ego functioning that “chooses” a fixed Gestalt, |
Loc: 8,968 | first a retroflection and then a confluence |
Loc: 9,090 | 5. Gestalt Therapeutic Process in Working with Dependent Clients |
Loc: 9,092 | involves the phenomenological, dialogical, field, and experimental elements of the overall Gestalt approach (Brownell, 2010a). |
Loc: 9,100 | Psychotherapy affects the abilities of the client, as described by Malcolm Parlett (2000): |
Loc: 9,101 | (1) try new things and to become more creative in meeting his or her needs (referred to as experimenting); |
Loc: 9,103 | (2) develop the ability to be more in touch with his or her body (referred to as embodying) and the senses that inform about contacting in the environment; |
Loc: 9,105 | (3) expand upon abilities to recognize (referred to as self-recognizing) and appreciate his or her experience of self; |
Loc: 9,107 | (4) the capacity for relationship (referred to as inter-relating), and |
Loc: 9,109 | (5) the ability to take responsibility for his or her own experience, including the choices the client makes and the natural consequences of making those choices (referred to as self-responsibility). |
Loc: 9,112 | Research has shown success in the use of motivational interviewing (MI) and mindfulness in dealing with substance |
Loc: 9,114 | MI works in the impasse between the polarity of relapse vs recovery and helps the client resolve that impasse by exploring his or her own subjective experiences and figures of interest |
Loc: 9,115 | that is consilient with a modified phenomenological method and dialogical relationship in Gestalt therapy. |
Loc: 9,117 | the awareness work commonly associated with mindfulness is consilient with Gestalt therapy |
Loc: 9,118 | acceptance and commitment therapy (ACT) should be just as applicable since ACT is consilient with Gestalt therapy’s paradoxical theory of change |
Loc: 9,122 | Gestalt process has long been associated with awareness and tracking of the client’s phenomenal field, claiming that everything having effect is relevant to the current situation. |
Loc: 9,123 | therapists working with dependent clients need to not only understand field effects, they also need to deliberately and strategically intercede at the level of the field to provide support and influence while working in a multi-systemic fashion |
Loc: 9,125 | and provide multiple pro-recovery resources. |
Loc: 9,125 | they might need to consult with other service providers in order to secure services in the best interest of their clients. |
Loc: 9,134 | Gestalt therapists work to expand the client’s lifeworld, and that takes the process beyond the uni-dimensional exploration of the client’s subjective experience. |
Loc: 9,136 | Therapy with addicted persons has to be multidimensional and multimodal. |
Loc: 9,136 | therapy of body, soul, spirit and the social environment. |
Loc: 9,139 | Recovery, |
Loc: 9,139 | also often includes the spiritual dimension of a person’s life. |
Loc: 9,141 | Gestalt therapists would do well to consult Gestalt-oriented discussions of spirituality |
Loc: 9,143 | For many clients this is an essential part of their recovery. |
Loc: 9,235 | 6.3. Some Final Clinical Considerations |
Loc: 9,252 | Therapists working with patients that are severely suffering from dependent behaviors have also to learn that there are |
Loc: 9,252 | limits in therapy, that they cannot help or save all patients in getting free of their dependency. |
Loc: 9,257 | As with many issues in current mental health, substance dependence treatment is ruled by the cognitive-behavioral perspective in psychotherapy. It need not be that way. Gestalt therapy is an effective approach that assimilates and organizes nicely many of the salient features in addictions work. |
Loc: 9,259 | This chapter has been offered as an alternative and as a suggestion. |
Loc: 9,261 | Gestalt therapy is a consistent and satisfying way to work, and it allows for a deepening of the supportive relationship between therapists and clients who struggle while feeling out of control and desperate for change. |
Loc: 9,264 | Comment |
Loc: 9,266 | by Nathalie Casabo |
Loc: 9,271 | If addicts self-medicate, it is precisely to be self-sufficient. |
Loc: 9,274 | Unlike people, a drug is always available, soothing, boosting, euphoriant, etc. and especially not confrontational. |
Loc: 9,275 | asking for help is an extremely difficult step for these people used to being self sufficient |
Loc: 9,280 | The contact mode of dependant persons – from sensation to action (Clemmens, 1997) – |
Loc: 9,281 | Grasping the instant when the addict wishes to undertake a process of recovery |
Loc: 9,282 | can allow him to effectively engage himself in the process |
Loc: 9,284 | requiring abstinence before beginning the therapy, |
Loc: 9,285 | is counterproductive, |
Loc: 9,286 | Doing the consultation, even with the person heavily drunk, |
Loc: 9,286 | seems essential to me, |
Loc: 9,287 | Many patients quickly abandon their commitment to obtaining help if they feel judged and/or treated like a child. |
Loc: 9,288 | accepted as they are, including in an intoxicated state, reinforces the therapeutic alliance |
Loc: 9,295 | if abstinence is a necessary condition, it is not sufficient (Clemmens, 1997) |
Loc: 9,298 | For a period, depending on each particular person, you have to be as available as the drug, |
Loc: 9,299 | accept being a kind of transitional object. |
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