Therapy process: What we see depends
from where we look.
Jan Roubal
2021
Process of change in Gestalt therapy
three perspectives
1. mono-personal pespective
2. bi-personal perspective
3. field theory perspective
change
Case example:
Different ways of working
• Steven came because of his sleeplessness and pain in the stomach.
• he suffers from the despotic behaviour of his current boss in his job
• this boss is similar to Steven’s father, a soldier who died six years
ago
• always submissive towards his father
• he also chose his current job according to the father’s wish
• the way of contacting others influenced by this experience with his
father
• he learned to live according to the expectations of others
Mono-personal perspective
Conceptualisation:
• Lack of support for learning to recognize his own needs
• Lack of support to step self-consciously into the
relationships with the environment to fulfil his needs
• Creative adjustment - fulfilling the needs of others.
• Retroflection of own impulses, needs and wishes.
17th session:
Mono-personal perspective
In the first part of the session, Steven speaks quietly, looking at the floor and
breathing very shallowly.
• Therapist: “Could you now for a little while focus on how you are
breathing?”
• Steven: “Well, I am not breathing, in fact...”
• Therapist: “Hmm..., and how does that feel?”
• Steven: “I don’t know... Unpleasant, I have no power for anything.”
• Therapist: “I see. You feel you have no power for anything... Well, what
would you need then?”
• Steven: “I don’t know... nothing... Do you think that... ehh? “
• Therapist: “What would your body need?”
• Steven: “Well, to breath in, that’s clear. But for some reason, I do not do
it... strange...”
• Therapist: “What seems strange to you?”
• Steven: “That I need something and I don’t do it.”
Mono-personal perspective
Interventions:
• suggestions for increasing awareness
• in a supportive relationship
• lead to recognition of a repeating pattern
• later to taking responsibility for the pattern
• and developing an alternative way.
Bi-personal perspective
Conceptualisation:
• After the formative experience with his father, Steven is used to
put himself into a submissive, even obedient position.
• We don’t see the phenomena mentioned above (retroflection of
impulses, needs, and wishes) as belonging to the client now,
• rather we see them as co-created by both the client and the
therapist in the therapeutic situation.
Bi-personal perspective
Steven speaks quietly, looking at the floor and breathing very
shallowly.
• Therapist: “Could you tell me how you are feeling right now?”
• Steven: “What?... Well, just normal...”
• Therapist: “I noticed you are almost not breathing.”
• Steven: “Yeah, that’s ... I ... yeah, you’re right, I am not breathing.”
• Therapist: “Is there anything I could do that it would be easier for
you to breath now here with me?”
• Steven: “What? ... That’s a strange question... oh, please excuse me,
I did not mean to criticize or...”
• Therapist: “That’s fine with me... and how is your breathing now?”
• Steven: “It’s better!... How did you do that?”
• Therapist: “I don’t know, we might have done that together
somehow... Don’t you have an idea, how could it happen?”
Bi-personal perspective
Interventions:
• The crucial process is happening on the relational level now.
• On one hand, Steven and the therapist are repeating the usual
pattern with Steven being submissive and therapist speaking from a
position of an authority.
• On the other hand, however, Steven has a chance for going through
a new relational experience
• with an authority, who is interested in his opinion and is willing to
adjust to his needs.
• Such a repeating experience with the therapist can lead to Steven’s
bigger self-confidence and courage to step forward in the contact
with others.
Field theory perspective
Conceptualisation:
• Insensitivity to own needs and retroflection are
phenomena of the field
• which exceed both the client as an individual,
• and also the relationship of the client and the therapist.
• These phenomena show how the field gets organized.
• Client and therapist are functions of the actual field
organisation,
• they are taken by the flow of the situation.
Field theory perspective
Steven speaks quietly, looking at the floor and breathing very shallowly.
• The therapist notices that and then he switches his attention from the client
back to himself, to his own experience here and now, especially to his body.
• He realizes that also he is not breathing freely. He is sitting on the chair slightly
leaning forward and trying to find out what would be a good way of working
with such a inhibited client.
• After becoming aware of this, he leans back to the chair, breathes in and
relaxes his body when breathing out.
• He lets go the expectation from himself (“I should find a good way of working
with such a client”), and grounds himself through the contact of his feet with
the ground.
• He feels more relaxed, looks at Steven, and smiles with a relief.
• Steven looks at him questioningly, then looks back to the floor.
• After a while of silence, Steven turns to the therapist: “You know, in fact I
would like to talk with you about something different now...” He speaks more
loudly and watches the therapist, his breathing is deeper.
Field theory perspective
Interventions:
• The therapist becomes aware of being taken by a field force,
• and he changes his own way of being in the situation.
• The therapist does not try to change Steven or their relationship.
• He is just aware of what is happening to him,
• he lets it be and adjusts his way of dwelling the situation.
• A new figure can now emerge from the transformed background.
• Through accepting the situation as it is, a chance for its
transformation opens up.
What is
changing
Psychopath
ology
symptoms
What the
therapy
aims for
How can the
therapist
support change
Dominant
self-
function
Theoretical
third party
Metaphor
mono-
person
al
perspe
ctive
The clients’
functioning
in the
relation with
the
environment
Limiting
fixed
patterns
created
originally as
creative
adjustments
New,
updated
creative
adjustments
Raising
awareness in
the supportive/
challenging
contact.
Ego-
function.
What the
client and
the
therapist
do in
therapy.
One-person
models of
functioning
(contact
styles,
sequence of
experience).
Tree and
gardener.
bi-
person
al
perspe
ctive
The
relationship
between
client and
therapist.
Individual
expressions
of a lack of
support in
the
relationship
Creating an
authentic
relational
experience
where the
symptoms
are not
needed any
more.
Enabling a new
relational
experience by
relating to the
client openly,
honestly, and
genuinely as a
person.
Personality
-function.
Who are
the client
and the
therapist
for each
other.
Co-creative
and dialogical
approach
(inclusion,
confirmation,
presence,
commitment
to dialogue).
Relational
dance: old
dance and
new steps.
field
theory
perspe
ctive
The way the
field gets
organized
here and
now.
Individual
expressions
of absences
of the field.
Spontaneou
s flow of
presence.
Letting oneself
being taken by
the field’s forces
and
transforming
own way of
Id-function.
Bodily
sensations
emerging
as a
function of
Field theory,
Paradoxical
theory of
change,
emergent
self,
Client and
therapist
in the
river,
being
moved by