Trauma and Dependent Behaviour Treatment

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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Trauma and Dependent Behaviour Treatment

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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

Ch. 16. The Power of “Moving on”. A Gestalt Therapy Approach to Trauma Treatment by Ivana Vidakovic  location 7488 - 7662

Ch 19. Dependent Behaviors, by Philip Brownell and Peter Schulthess  location 8703 - 9299

Loc: 7,488	Ch16. The Power of “Moving on”. A Gestalt Therapy Approach to Trauma Treatment.  by Ivana Vidakovic
Loc: 7,497	Trauma affects the wholeness of the person;
Loc: 7,499	some traumas surpass the range of human capability to process and to assign meaning to the experiences.
Loc: 7,520	2. The Diagnostic Process and Relational Considerations
Loc: 7,522	Gestaltists always refer to the relational experience in the “here and now”.
Loc: 7,523	we will describe what we can observe in a person with PTSD in process diagnostic terms.
Loc: 7,525	Too strong and inflexible or fluid and non-existant personal boundaries
Loc: 7,526	that could lead them to social isolation or inability to self-protect and the risk of multiple victimizations.
Loc: 7,527	The basic contact functions (eye contact, voice, hearing, touch/ posture/movement) are often changed after trauma,
Loc: 7,528	perceptive, emotional and cognitive processes
Loc: 7,529	are distorted, and significant shifts occur in judgement and Self evaluation
Loc: 7,531	Trauma, as the figure, becomes so compelling that the context is lost.
Loc: 7,532	the traumatised person is not able to widen the perceptual field to allow other aspects of life to become figural
Note:	(Avery, 1999).Avery A. (1999), “Letter to British Gestalt Journal”, British Gestalt Journal, 8, 1: 55.
Loc: 7,533	Id functions
Loc: 7,534	suppressed, the person has restricted needs and interests,
Loc: 7,534	Ego function
Loc: 7,535	is lost in an inability to cope with trauma,
Loc: 7,535	continuity of Personality function
Loc: 7,535	has disappeared, the person as he/she used to be no longer exists,
Loc: 7,536	new experiences are not integrated and a new persona has not yet arisen after the life-changing event.
Loc: 7,537	The contact cycle is stuck in demobilisation from traumatic experience,
Loc: 7,538	further interrupted by desensitization (emptiness, numbing)
Loc: 7,538	and/or deflections (negation, avoidance, projections, etc.).
Loc: 7,540	We can observe people suffering from trauma as agitated or withdrawn and inhibited,
Loc: 7,541	with overwhelming and mixed emotions,
Loc: 7,541	or sometimes with a blocked emotional response, fragmented and generally less available for contact in the here in now.
Loc: 7,543	The relational dimension in the therapy refers to the capacity for contact, relationship, trust and intimacy,
Loc: 7,544	also to the projections, transference and counter-transference in the client-therapist interpersonal experience.
Loc: 7,545	therapist has to be alert
Loc: 7,545	they could bring trauma elements into the here and now and make them available for exploration.
Loc: 7,546	common relational issues in therapy with trauma clients
Loc: 7,546	stability/instability, trust/mistrust and power/helplessness.
Loc: 7,551	3. Gestalt Model of Trauma, PTSD and its Application
Loc: 7,556	Trauma has been considered broadly as an adverse event
Loc: 7,557	the phenomenology of post-traumatic reactions in intrusion, avoidance, numbing, and hyper-arousal,
Loc: 7,558	«Uncompleted situations from the past, accompanied by unexpressed feelings never fully experienced or discharged,... they obstruct our present-centered awareness and authentic contact with others»
Loc: 7,563	«Avoidance is the means individuals use to prevent themselves from completing “unfinished business”... Avoidance exists for good and sufficient reason, and hence the task is to become aware of the reasons for its existence
Loc: 7,570	Developing further the Gestalt knowledge on trauma, Melnick and Nevis suggested that PTSD is a manifestation of the difficulties in demobilization, as the final stage of the cycle of experience, and an individual’s inability to absorb and digest an unhealthy experience in order to achieve disengagement (Melnick and Nevis, 1992; 1997a; 1997b; 1998).
Loc: 7,572	the experience is too charged to be easily absorbed, the old figure remains un- integrated and has a perpetually distorting effect on the current and future experience of the individual (Melnick and Nevis, 1997a).
Loc: 7,574	start with enabling the client to turn away from the traumatic figure.
Loc: 7,575	Encountering the void is the most difficult phase but, when completed, leads to acknowledgement of the emergence of something new about the self (Melnick and Nevis 1992; 1998).
Loc: 7,577	Some further advances in the Gestalt approach to trauma treatment have been developed more recently. Butollo has written about post-traumatic development of Self, with loss of empathy and reactive narcissism as two possibilities for reactions of the traumatized Self (Butollo, Kruesmann and Hagl, 2000).
Loc: 7,579	a therapeutic process through the phases
Loc: 7,580	Safety
Loc: 7,580	(Feeling safety, Establishing therapeutic relationship, Learning techniques of relaxation, breathing, Differential work with symptoms, Facing avoidance, Activation of social support resources),
Loc: 7,581	Stability
Loc: 7,581	(Overcoming insecurity, Self-acceptance, Self-reflections in contact with others),
Loc: 7,582	Confrontation
Loc: 7,582	(Activation and protection of Self-boundaries, Cognitive and emotional processing of trauma)
Loc: 7,583	Integration (Acceptance of what happened, Acceptance of Change, I-Thou dialogue with trauma).
Loc: 7,584	Cohen (2002; 2003) explained
Loc: 7,585	two-dimensional polarities: a continuum from extreme arousal and agitation to low arousal and numbness; and
Loc: 7,586	continuum from over involvement (re-experience, flashbacks and rumination) to total avoidance of stimuli
Loc: 7,610	4.1. Gestalt Trauma Treatment
Loc: 7,611	a particular focus on relational aspects
Loc: 7,612	working with dialogical interventions to strengthen the ability for contact, and helping the client to finish unresolved traumatic experience in a dialogical way
Loc: 7,614	treats the wholeness of a person affected by trauma.
Loc: 7,614	phenomenological method
Loc: 7,614	leads to the slow, minute-by-minute process of examining the original experience and recognition of interruptions in the process of assimilation and disengagement.
Loc: 7,615	phenomenological stance
Loc: 7,616	offers the possibility of distancing from the overwhelming past experiences
Loc: 7,616	focusing the healing process on the present moment
Loc: 7,617	resources and supportive elements existing in the Self and its environment at the present time.
Loc: 7,618	the relationship and process are more valuable than content and techniques.
Loc: 7,619	The I-Thou dialogue, with presence, inclusion, and confirmation, is a method,
Loc: 7,619	but also a desired achievement in the therapy.
Loc: 7,621	in work with trauma affected people can be supported by useful specific Gestalt interventions like
Loc: 7,622	experimenting;
Loc: 7,622	empty chair or two-chair work,
Loc: 7,622	working with the “here and now”,
Loc: 7,622	reassuring “I statements”, etc.
Loc: 7,623	Other interventions commonly integrated in a Gestalt approach are
Loc: 7,623	dream work and visualization, bodywork, breathing exercises, relaxation, and meditation, rituals, therapeutic writing, etc.
Loc: 7,624	curative skills can help trauma survivors to become re-grounded, re-centred
Loc: 7,626	The healing happens in the process between two (or more) persons – client(s) and therapist.
Loc: 7,627	each relationship and therapy is different.
Loc: 7,629	4.1.1. Re-Establishing Self-Regulation and Boundaries of Traumatized Self
Loc: 7,631	ability for self-regulation and reaching homeostasis is lost,
Loc: 7,631	encourage the client to increase self-care and healthy habits (nutrition, sleep, walk).
Loc: 7,632	whenever the traumatic figure is too prominent,
Loc: 7,632	important that the client re-establishes self-control and a sense of safety in the “here and now” moment.
Loc: 7,633	therapist supports the client to tolerate sensations, tensions and emotions by directing and focusing attention to the present moment;
Loc: 7,635	Respecting client’s boundaries and willingness is also important
Loc: 7,635	to avoid slipping into the parallel process with previous victimization.
Loc: 7,636	The therapist encourages the client to be an active participant;
Loc: 7,636	able to follow and choose what may happen in the course of therapy.
Loc: 7,639	4.1.2. Re-Establishing Self and Context Awareness and Contact Functions
Loc: 7,640	If the person has reacted during and after trauma with a strong dissociation of sensations and affects, the split of the “observing self” and the “experiencing self” could last a long time, causing disconnections from the context, and restricting clients from feeling sensations and emotions.
Loc: 7,646	Bringing the traumatized client back in contact with his/her body is a delicate and long-lasting part of the therapy
Loc: 7,647	the important part of trauma therapy is to realize how trauma is still represented in the body and to externalize it
Note:	(Kepner, 1995) Kepner J.I. (1995), Healing Tasks: Psychotherapy with the Adult Survivors of Childhood Abuse, GIC Press/ Jossey-Bass, San Francisco.
Loc: 7,650	4.1.3. Re-Approaching Trauma - Working with Avoidance and Intrusions
	Note: Throughout the process, the client is constantly encouraged to practice awareness, inclusion and dialogue. Still, we should always be aware of the high risk of re-traumatisation, particularly in applying exposure techniques without building sufficient support for the traumatized person to endure a new approach to the trauma. (loc7663)
Loc: 7,652	Working on the client’s traumatic experiences often requires re-approaching or re-enacting the original situation
Loc: 7,652	allowing the associated affect to be experienced and expressed.
Loc: 7,653	difficult to stand the recurrent and disturbing recollections of the event, including perceptions, images, thoughts or dreams.
Loc: 7,654	Self-calming  (relaxation and visualization techniques – a safe place, feeling the ground and the roots...)
Loc: 7,655	and systematic controlled exposure (setting a 10 minutes each day in which the person will recall or allow trauma memories)
Loc: 7,655	with an attitude of “acceptance and let it go”(mindfulness)
Loc: 7,656	can enable trauma survivors to regain control over intrusive contents.
Loc: 7,657	The Gestalt experiment can be engaged as an exposure technique to the trauma-related stimuli:
Loc: 7,658	to revisit the scene and re-experience it
Loc: 7,658	retelling the details of the traumatic event, sensations and emotions as if it were happening in the present.
Loc: 7,659	With support from the therapist, the client encounters an impasse or the trauma content and emotions that he/she is avoiding.
Loc: 7,660	The therapist is involved,
Loc: 7,660	reassuring the client to endure and go through the experience,
Loc: 7,661	offering awareness of the here and now moment where the survivor’s Self in relationship with the therapist is present, safe and alive.
Loc: 7,667	4.1.4. Coping with Overwhelming Negative Emotions and Thoughts - Building Capacity for Acceptance
Loc: 7,671	The expression and processing of authentic emotions is supported.
Loc: 7,671	Instead of denying, blaming, overtaking or displacing responsibility
Loc: 7,672	the individual is encouraged to accept thoughts, feelings, and actions
Loc: 7,672	in the past and present,
Loc: 7,673	as parts of the Self
Loc: 7,673	and its limitations.
Loc: 7,673	the capacity for acceptance helps the client to accept
Loc: 7,674	and re-build a life with dignity
Loc: 7,674	Gestalt dialogical interventions are helpful
Loc: 7,674	“empty chair” as a chance to directly voice anger,
Loc: 7,675	“two chairs” for “top dog-under dog” dialogue
	(when the client is overwhelmed with guilt and self-accusation. Loc 775)
Loc: 7,677	4.1.5. Re-Building a Social Support System and Involvement in Interpersonal Relationships
Loc: 7,679	The interpersonal support, from family, friends and a wider social network,
Loc: 7,680	have tremendous healing potential.
Loc: 7,681	clients often bring to treatment
Loc: 7,681	disturbance in interpersonal functioning:
Loc: 7,682	try to protect important relationships, withdrawing from contact.
Loc: 7,683	The specific interpersonal dynamic related to trauma
Loc: 7,684	appears in therapy
Loc: 7,684	the therapist has to be alert
Loc: 7,684	When the client
Loc: 7,685	looks for an experience where
Loc: 7,685	new assumption might be tested
Loc: 7,685	the relationship with the therapist becomes important:
Loc: 7,686	important to remain stable, safe and in a clear setting
Loc: 7,687	as a human-being with realistic and limited abilities.
Loc: 7,691	4.1.6. Transformation of Meanings, Trauma Disengagement, Integration and Completion
Loc: 7,694	clients need to re-establish a cognitive support system.
	Before being available for trauma disengagement, integration and completion)
Loc: 7,694	basic assumptions about the world and oneself are challenged,
Loc: 7,695	task of therapy is also to reconstruct fundamental personal beliefs
Loc: 7,696	revive positive thinking;
Loc: 7,696	restore a system of values and beliefs,
Loc: 7,696	help clients to regain hope, faith, and a perspective on the future.
Loc: 7,700	Reframing helps the client reach a new perspective beyond the individual experience;
Loc: 7,701	client and therapist are looking for a context and a frame that can give a universal perspective and new meaning
Loc: 7,702	Therapeutic writing and other artistic expression can help to integrate the trauma experience
Loc: 7,703	Completion and integration are achieved when life before and after the trauma are perceived as parts of a meaningful continuum,
Loc: 7,718	The unaddressed and unhealed trauma can be re-enacted
Loc: 7,719	through acting-in
Loc: 7,719	(alcoholism, substance abuse, depression, work-holism, physical ailment, suicide, etc)
Loc: 7,719	acting-out
Loc: 7,719	(aggressive behavior, repetitive conflicts, high-risk behavior, domestic or interpersonal violence, etc.)
Loc: 7,721	«Pain that is not transformed, is transferred» (Rohr in Yoder, 2005).
	Yoder C. (2005), The Little Book of Trauma Healing: When Violence Strikes and Community Security is Threatened, Good Books, Intercourse PA.
Loc: 7,728	6. Existential Perspective in Trauma Healing and Post Traumatic Growth
Loc: 7,731	People can not only survive trauma, they can also experience growth
Loc: 7,732	Post-traumatic growth includes positive transformative dimensions,
Loc: 7,732	appreciation of life,
Loc: 7,732	shift in priorities,
Loc: 7,733	deepening of spiritual life,
Loc: 7,733	fostering positive attitudes and emotions.
Loc: 7,733	Continuous transformation occurs
Loc: 7,734	it is a process and not just an outcome
Loc: 7,736	important to be realistic and honest,
Loc: 7,737	to recognize that for some of the severely traumatised clients even limited gains are appreciated.
Loc: 7,739	with war-affected clients
Loc: 7,739	also recognize enormous human potential for endurance and creative adaptation
Loc: 7,743	The resilience and post-traumatic growth
Loc: 7,744	can be recognized through
Loc: 7,744	their ability to pass on wisdom to others.
Loc: 7,662	The client is helped to reach closure and to gradually disengage from the experience.
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	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).
	Note: 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
	Note:«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.