august 2018/06
Gestalt Therapy Kairos Institute
06 Psychopathology
ISSN 2039-5337
JOURNAL OF PSYCHOTHERAPY
Gestalt Therapy hcc Kairos Institute Post graduate school in Gestalt Psychotherapy
In its quarter of a century, the institute significantly contributed to the history and progression of Gestalt psychotherapy, forming about a thousand psychotherapists and intersecting various and fruitful relationships of cooperation and affiliation with many national as well as international corporations and bodies directed to scientific exchange and the research in the specific field of psychotherapy and treatment connections. From the beginnings, the institute has been in contact with Gestalt psychotherapy founders that were living at that time – Isadore From, Jim Simkin – and handled to start didactic and scientific exchanges with the most illustrious representatives of second generation Gestalt therapists – E. Polster, M. Polster, S.M. Nevis, Ed Nevis, R. Kitzler and others – committing themselves to international research projects about Gestalt psychotherapy theory and therapy. The institute weaved didactic and scientific exchanges with the most prestigious Gestalt therapy institutes in Italy and abroad, as well as with the most qualified Gestalt Therapy associations worldwide, maintaining relationships of cooperation. In 2001, the institute started a collaboration with the Università Cattolica del Sacro Cuore, establishing second level Master courses, arrived at its 16th edition.
THE INSTITUTE ORGANISES ■ Second level Master degrees in “Paths of prevention and treatment of sexuality. Gestalt Therapy and interpersonal relations” in cooperation with the Università Cattolica del Sacro Cuore, Faculty of Medicine and Surgery in Rome. ■ Second level Master degrees in “Family Mediation” in cooperation with the Università Cattolica del Sacro Cuore, Faculty of Psychology in Milan ■ CME Continuing Medical Education courses ■ Training and further education courses for teachers ■ International training in Gestalt Family Therapy AFFILIATIONS EAGT (European Association for Gestalt Therapy) NYIGT (New York Institute for Gestalt Therapy) SIPG (Società Italiana di Psicoterapia della Gestalt) FISIG (Federazione Italiana Scuole e Istituti di Gestalt) CNSP (Coordinamento Nazionale Scuole Psicoterapia) FIAP (Federazione Italiana delle Associazioni di Psicoterapia). EAP (European Association for Psychotherapy) WEB www.gestaltherapy.it BLOG www.gestaltherapy.it/blog/ OFFICES RECOGNISED BY THE MIUR Sicily Ragusa / Latium Rome / Veneto Venice D.M. 9.5.94, D.M. 7.12.01 e D.M. 24.10.08 SCHOOL MANAGEMENT AND SCIENTIFIC COMMITTEE Giovanni Salonia Scientific responsible Valeria Conte Responsible of didactic Antonio Sichera, Member of scientific committee Erminio Gius, Guarantor of the scientific committee until 2017
FOUR-MONTHLY JOURNAL OF PSYCHOTHERAPY ON LINE GESTALT THERAPY KAIROS JOURNAL OF PSYCHOTHERAPY Scientific Director Giovanni Salonia Managing Director Orazio Mezzio Chief Editor Concetta Bonini Laura Leggio Law Office Silvia Distefano Scientific Committee Angela Ales Bello Vittoria Ardino Paola Argentino Eugenio Borgna Vincenzo Cappelletti Piero Cavaleri Valeria Conte Ken Evans Sean Gaffney Erminio Gius Bin Kimura Aluette Merenda Rosa Grazia Romano Antonio Sichera Christine Stevens Editing Luisa Pacifico Sergio Russo Translations and English Consultancies Luisa Pacifico Graphic project Marco Lentini Pagination Paolo Pluchino Illustrations Angelo Ruta
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The texts of GTK Journal of Psychotherapy are subjected to a system of double blind peer-review. GESTALT THERAPY KAIROS International journal of psychotherapy Address for all correspondence: GESTALT THERAPY KAIROS Journal of psychotherapy Via Virgilio, n°10 97100 Ragusa Sicilia Italia Enquiries: Editorial +39 0932 682109 Subscriptions +39 0932 682109 FAX +39 0932 682227 Email: redazione.gtk@gestaltherapy.it Website: www.gestaltherapy.it
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Anxiety
INDEX
INDEX Editorial...................................................................................... pag. 7 In this issue............................................................................. pag. 11 Research.................................................................................... pag. 15 The fragmenting of the ‘on-betweens’ in alzheimer’s disease. And i will look after you: mending lost wefts. Grace Maiorana and Barbara Buoso The heart of co-parenting in Gestalt Therapy Interview with Valeria Conte and Giovanni Salonia Aluette Merenda New clinical pathways.................................................. pag. 61 The violinist’s cramp Gestalt Therapy in the treatment of Focal Hand Dystonia of a musician’s hand Giovanni Turra and Elena Ponzio Society and psychotherapy........................................ pag. 77 From roots to leaves Vitality and development of Gestalt Psychotherapy Serena Bimbati Honesty as therapeutic competence Giovanni Salonia Readings................................................................................... pag. 107 Adam Kincel
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Psychotherapy
EDITORIAL
EDITORIAL With the publication of its sixth issue, GTK tends to show its own versatility in a more and more distinct way and profess a multidimensional vision of Gestalt Therapy. It is a process of progressive expansion in this field − compared to the first issues, which were focusing on primary topics − broadening its view towards different horizons and manifold matters. However, the common thread is unchanged: there is the certainty that the model originated in the nineteen-fifties in New York is still genuinely up to date, when it comes to clinical research as well as art, interpretation of society and history, and therapeutic approach. Indeed, the real core of this issue is the hermeneutical flexibility of Gestalt Therapy. From the point of view of Gestalt, one can usefully read and fruitfully intervene on one of the most painful and common pathologies of our times: the Dementia of Alzheimer’s disease, which Grace Maiorana and Barbara Buoso interpret according to the “on-between” category. However, from a Gestalt perspective, one can talk with sharpness, acceptance of everyday life and humanity about the huge challenge of being a parent or, in other words, to be together as fathers and mothers in a time that is allergic to any strict definition of roles and authorities. This is the sense coming out from Aluette Merenda interviewing Giovanni Salonia and Valeria Conte, closing the ‘Research’ section. After all, Gestalt Therapy can work as a comprehension path and as an alternative resolution of typical distress of aesthetic sensitivity in its finest sense, such as the so-called “violinist’s cramp” (explained in a very clever way by Giovanni Turra in his ‘New clinical applications’). All things considered, this is done for a spontaneous acceptance of social changes that generates the actual model, the result of an encounter of migrant intellectuals, who belong to different cultures and social backgrounds (the outcome of the nice survey by Serena Bimbati); it is also done to give attention to the thorniest topics of our times, such as the autoregulation of therapeutic relationships with regards to the massive rock of honesty, which Giovanni Salonia faces with lightness and expertise in his essay ending the section ‘Society and psychotherapy’. The accurate review by Adam Kincel on “The moon is made of che-
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ese� enshrining a valuable dialogue between the GTK Institute and the British Gestalt Journal (the author is a spokesperson of it) closes the sixth stage of this journey. The entire publication is embellished and enlivened by the stunning illustrations created by Angelo Ruta.
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THE PUBLISHING GTK JOURNAL OF PSYCHOTHERAPY (ON-LINE AND BILINGUAL) GTK SERIES, WITH THE PUBLISHER IL POZZO DI GIACOBBE DIAPATHOS SERIES, WITH THE PUBLISHER CITTADELLA
Psychopathology and new clinical practice Developmental theory and family therapy title Devo sapere subito se sono vivo authors G. Salonia, V. Conte, P. Argentino pages 296 publisher Il Pozzo di Giacobbe year of publication 2013
title Danza delle sedie author G. Salonia pages 160 publisher Il Pozzo di Giacobbe year of publication 2015
title La luna è fatta di formaggio edited by G. Salonia pages 176 publisher Il Pozzo di Giacobbe year of publication 2014
title Come l’acqua… authors D. Iacono, G. Maltese pages 96 publisher Il Pozzo di Giacobbe year of publication 2012
title Incontri terapeutici edited by A. Merenda pages 152 publisher Il Pozzo di Giacobbe year of publication 2014
title Edipo dopo Freud authors G. Salonia, A. Sichera pages 96 GTK-books/01 year of publication 2013
title Tra author B. Kimura pages 176 publisher Il Pozzo di Giacobbe year of publication 2013
title For Oedipus a new Family Gestalt authors G. Salonia, A. Sichera, V. Conte pages 135 GTK-books/02 year of publication 2013
Anthropology title Sulla felicità author G. Salonia pages 184 publisher Il Pozzo di Giacobbe year of publication 2011 title La grazia dell’audacia author G. Salonia pages 80 publisher Il Pozzo di Giacobbe year of publication 2012 title Comunicazione Interpersonale authors H. Franta, G. Salonia pages 170 publisher LAS year of publication 1979 title La casa vissuta author G. Giordano pages 224 publisher Giuffrè year of publication 1997 title Ogni giorno merita una gestalt edited by S. Antoci e A. Rusca pages 156 publisher Cittadella editrice year of publication 2014 Peter Pan ratura per l’infanzia. Presentata come la storia di un bambino che non vuole crescere, essa rivela in realtà la tendenza diffusa ad etichettare il comportamento dei bambini e a creare teorie salva-adulti: il complesso di Edipo, di Telemaco, di Peter Pan. Ma chi è Peter? Basta aprire il libro per scoprirlo: «Se voi, o io, o Wendy fossimo stati là, avremmo visto che Peter Pan assomigliava proprio al bacio della signora Darling». Il volto di Peter è quello del bacio che mamma Darling trattiene all’an golo della sua bocca: il bacio che non raggiunge Wendy, il suo desiderio, il suo corpo. Il bacio che sotto le specie del bottone di Peter di lì a poco le salverà la vita. Tale è lo sfondo ermeneutico da cui emerge in questo libro il punto di vista gestaltico su Peter. Con registri diversi: dalla teoria clinica alla psicoterapia infantile, dalla critica semantica al pensiero educativo. GIOVANNI S ALONIA, psicologo e psicoterapeuta. OFM Cap. Direttore stalt – HCC Kairòs (Ragusa, Roma, Venezia) e della rivista interna versità Antonianum e della Scuola di Specializzazione in Psichiatria presso l’Università Cattolica del Sacro Cuore di Roma.
Nel libro testi di D. Iacono e G. Maltese, G. Salonia, A. Sichera.
ISBN/EAN
9 788830 815025 EURO9,50
Journal of Psychotherapy ITA/ENG
title i come invidia edited by G. Salonia pages 112 publisher Cittadella editrice year of publication 2015 title La vera storia di Peter Pan edited by G. Salonia pages 84 publisher Cittadella editrice year of publication 2016
www.gestaltherapy.it
The pain
IN THIS ISSUE
IN THIS ISSUE
Grace Maiorana pag. 15 Psychologist and psychotherapist, graduated at the University of Urbino, studied Gestalt Psychotherapy at the Gestalt Institute H.C.C. She trained teaching and clinical supervising at the School of Specialization for Psychotherapy of the Gestalt Therapy Institute hcc Kairos. She works as a psychologist in a community for adolescents and coordinates a youth centre. Her areas of professional interest include teenage-related problems with regards to juvenile penal law, clinical neuropsychology and metacognitive rehabilitation (Instrumental Enrichment Programme Applicator 1st2nd level - Feuerstein method). She is lecturer of two-year masters in Psycho-Pedagogical Counselling with a gestaltic orientation, and carries out clinical activities as a freelancer and research activities at the Gestalt Therapy Institute hcc Kairòs in Ragusa. Barbara Buoso pag. 15 She is an occupational psychologist at the University of Padua and Gestalt psychotherapist. She gained work experience in the socio-medical field, combining organizational aspects and therapy in different areas such as drug addiction, elderly, physical and mental disabilities. She lives close to Venice, where she is working as psychotherapist and collaborates with the Gestalt Therapy Institute hcc Kairos. Valeria Conte pag. 37 Psychologist, executive of the Mental Health Department of the provincial ASP of Ragusa; psychotherapist and regular Supervising teacher recognized by the FISIG (Italian Federation of Schools and Institutes of Gestalt). Member of the scientific committee and teaching and clinic responsible of the Gestalt Therapy Institute hcc Kairòs. Trained with the mayor national and international representatives of Psychotherapy of Gestalt, she has widened her specific background with specialization in family therapy and corporal therapy. She deepened the epistemological model of Gestalt Therapy in her work with psychiatric patients and in the work with couples and families, whereof publications in national and foreign journals.
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Aluette Merenda pag. 37 Psychologist and Gestalt Psychotherapist. Senior Researcher in Dynamic Psychology at the Department of Psychology, University of Palermo (Italy). Assistant Professor for the discipline “Psychodynamics of Development and of Family Relationships”, School of Scienze Umane e del Patrimonio culturale, University of Palermo. Invited Teacher at the Gestalt Therapy Kairos Institute in Ragusa (Italy) and at the Gestalt Italy HCC Institute (Human Communication Centre) in Palermo (Italy). Her main areas of research focus on: abused family relationships and young offenders; clinical zooanthropology and co-therapy models; coparenting in new family typologies. Giovanni Turra pag. 61 Psychologist and psychotherapist, specialized at the Gestalt Therapy Institute hcc Kairòs in Venice, the Centre of Studies for Gestalt Therapy in Milan and the Gestalt Centre in London. He also graduated in flute at the Conservatory of Music “A. Pedrollo” of Vicenza. He got trained at the ISSTIP in London, and deals with performance psychology with performing artists. Elena Ponzio pag. 61 She graduated in physiotherapy in Padua and also holds a degree in viola da gamba at the Conservatory of Music “A. Pedrollo” in Vicenza. She deals with orthopaedic and neurological rehabilitation. In particular, she follows the re-education of musicians suffering movement disorders and musculoskeletal disorders (especially in focal dystonia). Serena Bimbati pag. 77 She is a clinical psychologist and psychotherapist, who got trained at the Gestalt Therapy Institute hcc Kairòs. She holds a Master’s degree in Cultural Mediation and has been working for many years for the private social sector on projects aimed at migrants. She is currently doing private clinical activities and offers therapy services in a centre for medically assisted procreation in Verona. Moreover, she coordinates the psychological support desk for “Caritas Diocesana Vicentina”, and is the head of the psychic suffering commission and the coordinator of the reception projects of people asking for international protection.
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Giovanni Salonia pag. 103 Psychologist, psychotherapist, already professor of Social Psychology at the University LUMSA of Palermo. He teaches at the Università Pontificia Antonianum in Rome. Scientific director of the School of Specialization in Gestalt Psychotherapy of the Institute of Gestalt Therapy hcc Kairos (Venice, Rome, Ragusa) and of the second level Master degrees co-managed with the Università Cattolica del Sacro Cuore in Rome. He is a teacher wellknown internationally and he is invited to several italian and foreign universities, he was the President of the FISIG (Italian Federation of Gestalt Schools). He wrote Interpersonal Comunication (with H. Franta), Kairòs, Odòs, Sulla felicità e dintorni and as co-author, Devo sapere subito se sono vivo, La luna è fatta di formaggio, Danza delle sedie e danza dei pronomi as well as numerous articles published in national and international journals, they deal with anthropological and clinical themes. He founded and directed the journal Quaderni di Gestalt (19852002) and since 2008 he is the scientific director of GTK Journal on line of Psychotherapy. Adam Kincel pag. 109 Psychotherapist, supervisor, trainer and qualitative researcher. His doctoral research examined the role of social and sexual identity in the therapeutic process. He works as a course director at the Edinburgh Gestalt Institute as well as a trainer at Re-Vision (London) and several institutes in England, Poland, Bulgaria and Georgia. Before becoming a psychotherapist, he managed a mental health supported housing unit. Angelo Ruta Born in Ragusa in 1967, he got trained in Milan, where he attended a scenography course at the Brera Academy, the advanced illustration and comics course, and the school of cinema and TV related techniques. He mainly works as an editorial illustrator. Exceptionally, he deals with writing and directing for the cinema and the theatre. He worked with the main Italian and English publishing houses. He composed theatre shows and movies and also won some awards. He regularly collaborates with “La Lettura”, a Sunday insert of “Corriere della Sera”.
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Forgetful
RESEARCH
THE FRAGMENTING OF THE ‘ON-BETWEENS’ IN ALZHEIMER’S DISEASE AND I WILL LOOK AFTER YOU: MENDING LOST WEFTS by Grace Maiorana and Barbara Buoso Giovanna is an old lady with a very advanced stage of Alzheimer’s1. She does not speak anymore, she can barely see, she does not have control over her sphincters. She spends most of her day sitting on a chair in the ward’s living room, but she is always a little anxious, looking around as if she was afraid of something. One day her son comes to my studio full of despair. His mother’s condition got indeed worse, but whenever he goes to visit and gets closer to her, she spits and shouts at him, and tries to hit him. She is so stressed that the personnel has to intervene and send him away. He asks me: “Will I still be able to hug her before she leaves me forever?”. The idea of leaving this gestalt unresolved is such a pain! I decide to dedicate him several meetings, during which we try to retrace his mother’s and his family’s history. It turns out that Giovanna had been physically abused by her alcoholic husband up until he died. I ask him to bring a photo of his father and the resemblance is really astonishing! Maybe that is the reason why she rejects him. Maybe she thinks she is seeing her husband and now, for some reason unknown to us, she is allowed to spit at him. We decide to try the route of her son’s recognition by disguising him: he will have to wear a wig that resembles his hair when he was younger: he lost it when he was young and now looks like his dad because of it. So many tears rolled down in that new encounter… Giovanna recognizes her son and welcomes him, and with time she can
1 Alzheimer’s Disease is the most frequent neurodegenerative pathology: it represents 65% of the dementia syndromes. The neuropathological chart is characterized by a progressive cerebral atrophy with a thinning of the gray matter due to a diffused and progressive destruction of the neurons. Cf. C. Colosimo (2013), Neuroradiologia, Edra, Milan.
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even go to his house for lunch one Sunday, with her daughter-inlaw but not her grandchildren, who are now in their thirties and she would not even know of their existence2. The story of Giovanna and her son, in describing the clinic evolution3 of the pathognomonic symptoms of Alzheimer’s Disease (AD), tells about the wounds of those who suffer from it, more and more foreign to themselves and to others, and of the relatives who witness this progressive loss helplessly. The disease erodes memories4 in a backward direction: in the first years there is the loss of the most recent memories and then, gradually, of the autobiographic ones. This leads to the fact that the patients find themselves in a mental time frame that does not coincide with the chronological one5. Furthermore, there is the difficulty to place familiar faces in one’s acquaintances and to give an updated name and role to those faces. The patients live a perceptive reality which is not shared and, as a consequence, not understandable, so their actions often do not make sense and are sometimes dangerous for them or the others. Due to the cerebral affections that transversally deteriorate the memory function as well as the attentive, perceptive, emotional,
2 The stories in italics are true episodes of a care home in Mestre (Venice) for elderly people that are not self-sufficient, more precisely in the ‘Alzheimer’s’ ward. 3 The first few years of the disease are characterized by a progressive loss of the ability of learning new information and of evoking those previously learned. There are frequent difficulties in judgment, space-time orientation and language. As the disease progresses, memory is eroded and conscience integrity compromised. Cf. A. Damasio (2010), Self comes to mind: constructing the conscious brain, Pantheon Books, New York. 4 In AD memory is compromised in its explicit form (intentional, verbally expressible) even though the memory still exists and can be implicitly evoked (as associative or procedural memory). Cf. M. Boccardi (2002), La riabilitazione cognitive e comportamentale nella demenza: un approccio pratico per le R.S.A., Fatebenefratelli, Brescia. 5 The patients lose the correct time sequence of memories and assign information and events to the present, while they belong to the past. Cf. AA.VV. (2013), “Non so cosa avrei fatto oggi senza di te”. Manuale per i familiari delle persone con demenza, Servizio Sanitario Regionale Emilia-Romagna, Pazzini stampatore, Verrucchio (RN).
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The disease erodes memories in a backward direction
This leads to the fact that the patients find themselves in a mental time frame that does not coincide with the chronological one
The corporeal-identity-spatial-temporal sense of the self for the experience of being ‘between’ in the patient with AD is more and more dis-integrated
In AD patients, there is a feeling body, but it does not know what and who it is in the here and now: the experience splits and the Self is no longer an element of assimilation
linguistic and executive ones, the Organism is not able to be present ‘with clarity of mind’ in the experience. So, from the physical memory it retrieves the feelings which are activated by the actual experience, and then identifies and recognizes them as their own and makes intentional and adaptive choices. The corporeal-identity-spatial-temporal sense of the self for the experience of being ‘between’ in the patient with AD is more and more dis-integrated6. We know that the epicenter of the ‘on-between’7 is the body, because in sensing the changes in its boundaries of contact (sensory organs, skin, words), the brain processes its own representations of the environmental reality8. In AD patients, there is a feeling body, but it does not know what and who it is in the here and now: the experience splits and the Self9 is no longer an ele-
6 Cf. F.N. Gaspa, A. Nieddu (2010), Identità e Malattia di Alzheimer: una riflessione antropologica, in «Geriatria», XXII, 3, 75-78. 7 The buberian on-between, boundary of contact in Gestalt Therapy, is the space where every existential experience takes place. There are three different types of on-betweens or boundary of contact: primary on-between refers to the asymmetrical relation between growth and treatment; intrapersonal on-between can be described as an internal dialogue that allows awareness of one’s past. Intrapersonal on-between, pivotal space of equal relations, is declined in two different forms and expresses both the being-between (as background) and the process of going-towards (typical of the figure). Cf. G. Salonia (2013b), L’esserci-tra. Aida e confine di contatto in Bin Kimura e Gestalt Therapy, in B. Kimura, Tra. Per una fenomenologia dell’incontro, Il Pozzo di Giacobbe, Trapani, 5-20. 8 According to Gestalt Therapy, the mind is an ‘incarnate’ reality that emerges from the continuous interaction between the Organism and its Environment at the boundary of contact. Cf. P.A. Cavaleri (2003), La profondità della superficie. Percorsi introduttivi alla psicoterapia della Gestalt, Franco Angeli, Milan. 9 The Self, which in Gestalt Therapy is a function of the Organism in contact with the Environment, is the ‘integrative element’ of experience, that in fact integrates in a single gestalt of meaning the different elements (sensations, perceptions, emotions, mental images, actions, memories, thought, etc.). Cf. F.S. Perls, R.F. Hefferline, P. Goodman (1994) (or. ed. 1951), Gestalt Therapy: Excitement and Growth in the Human Personality, The Gestalt Journal Press, New York.
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ment of assimilation10. The functional continuity between the biological and psychological processes, between brain-body-mind and conscience of oneself, is altered. The Es-function11 of the Self manifests as the ability of feeling sensations, emotions, feelings that, nevertheless, cannot be elaborated12. The AD patients that are compromised as for perception, memory and representation are not able to decipher the corporeal sensations, do not recognize objects (agnosia) and people in the field (prosopagnosia), they have difficulties in using symbols and abstract concepts, they gradually lose the aware contact with their ground of basic and functional safeties13. The body/background is no longer able to access consciously to its integrated learnings and this does not allow to retrieve previous knowledge nor to acquire anything new. Therefore, «the continuity of the subjective experience entrusted to the body and played around the relation between awareness and nonawareness»14 (translated by the author) is interrupted. Words, their meaning, grammatical and syntactical rules are forgotten to the point that even building a structured sentence becomes difficult. Places which have always been familiar, even one’s own home, become unknown. The experience of not being able to recognize one’s own family, of not being able to remember one’s own name, is distressing. The patients forget the
10 Cf. A. Damasio (1995), L’errore di Cartesio. Emozione, ragione e cervello umano, Adelphi, Milan. 11 The Es-function of the Self is the physical experience: what one feels in the body, sensations, emotions, physical past. About this, cf. G. Salonia (2012a), Theory of self and the liquid society. Rewriting the Personality-function in Gestalt Therapy, in «GTK Journal of Psychotherapy», 3, 29-57. 12 There are issues in the secondary elaboration of perception, in the associative phase that allows direct and automatic attribution of a meaning to the perception. Cf. M. Boccardi (2002), La riabilitazione cognitiva e comportamentale nella demenza: un approccio pratico per le R.S.A., cit. 13 Cf. G. Salonia (2013), Disagio psichico e risorse relazionali, in G. Salonia, V. Conte, P. Argentino (eds.), Devo sapere subito se sono vivo. Saggi di psicopatologia gestaltica, Il Pozzo di Giacobbe, Trapani, 55-68. 14 A. Sichera (2013), Dalla frattura freudiana alla continuità gestaltica: lo scarto epistemologico di Gestalt Therapy, in G. Salonia, A. Sichera (eds.), Edipo dopo Freud, GTK-books/1, 49-59, 47.
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The body/background is no longer able to access consciously to its integrated learnings and this does not allow to retrieve previous knowledge nor to acquire anything new
The being-between oneself and the Environment become, therefore, less and less taken for granted for the patients
purpose of the actions they are performing, their ideas suddenly disappear: everything darkens, causing uncertainty and bewilderment. They are not able to plan and organize actions in sequence (ideomotor and ideational apraxia)15. All of this makes them apathetic and without any interest. Gradually, they lose the emotive ‘harmony’ that is typical of interpersonal relations. The symptoms, episodic at the start, progressively combine, increasing in frequency16. The being-between oneself and the Environment become, therefore, less and less taken for granted for the patients: they lose the sense of the familiar and the experience of the safety of being in the world17. The ground, consisting of the physical being, the recollection of themselves and the Environment they are in, is gradually fragmented and the patients lose their sense of rooting, and move without any point of reference18. Moreover, the process that makes new figures arise, starting from a background of stable and safe contacts, is compromised by the deficient attention19, by the altered secondary perception and the working memory deficits20. Hence, the movement towards the 15 Ideational apraxia concern complex sequences of finalized movements, while ideomotor ones concern simple gestures. The most evident apraxia in patients concern the inability of performing complex and purposed sequences. The executive component of planning is compromised, while simpler tasks, such as dressing up, doing chores, etc., can still be performed. Cf. M. Boccardi (2002), La riabilitazione cognitiva e comportamentale nella demenza: un approccio pratico per le R.S.A., cit. 16 Cf. V. Andreoli (2015), La demenza di Alzheimer, http://anchise. net/2015/04/14/la-demenza-di-alzheimer/. 17 Cf. V. Conte (2013), La Gestalt Therapy e i pazienti gravi, in G. Salonia, V. Conte, P. Argentino (eds.), Devo sapere subito se sono vivo, cit., 69-94. 18 Cf. F.N. Gaspa, A. Nieddu (2010), Identità e Malattia di Alzheimer, cit. 19 The first attentive functions to be compromised in AD patients are divided attention (paying attention to more tasks at once) and spacial attention. Selective attention and sustained attention are also compromised. Cf. M. Boccardi (2002), La riabilitazione cognitiva e comportamentale nella demenza: un approccio pratico per le R.S.A., cit. 20 The working memory (memory function with a relevant frontal component) allows to keep the elements, on which other functions have to work, ‘active’ and available. In AD patients, this function is compromised, including also the ability of the patients to elabo-
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Environment is not clear, as the energy is not defined or loses direction, and the patient fails in the intentionality of contact. The Organism loses itself and does not manage to arrive in one piece, with its whole self, to the boundary of contact with the other and, therefore, cannot co-create a new on-between21 with the Environment. The dynamism of the intrapersonal backgroundfigure on-between as functional principle of the contact Organism is compromised. As the neural degeneration progresses, AD patients lose their autobiographic memory22 as well as the verbal-narrative-historical component of their identity23, built by the assimilation of the relational experience they lived, which are necessary to recognize themselves in a definition of the self and to feel the meaning of their ‘continuity’ in time24. They progressively lose the ability to represent themselves and to be in contact with the image of themselves. This memory, which Gestalt Therapy defines Personality-function25, represents the ‘experienced biography’ as corporeal memory of contact experiences26. Patients lose the declarative, episodic and semantic access to this function, denying the intrapersonal dialogue, or in other words, talking to themselves about what happens to them, which is one’s own self-awareness27. Patients lose themselves
rate the environmental stimuli, to understand them and to organize their behaviour. Cf. ibid. 21 Cf. G. Salonia (2012b), Il paradigma triadico della traità. I contributi della Gestalt Therapy e di Bin Kimura, in A. Colonna Romano, Io-tu. In principio era la relazione, Il Pozzo di Giacobbe, Trapani, 27-36. 22 Cf. A. Damasio (2010), Self comes to mind: constructing the conscious brain, cit. 23 Cf. C. Angelini (2013), Alla ricerca dell’identità perduta. La Gestalt Therapy e la domanda-chiave della postmodernità: “Chi sono io?”, Tesi di Specializzazione della Scuola di Specializzazione in Gestalt Therapy, Istituto di Gestalt HCC Kairos, institute of Rome. 24 Cf. G. Cipriani, G. Borin, N. Taglialegna, A. Bani (2010), Temporalità ed identità nella malattia di Alzheimer, in «Psicogeriatria», 2, 36-39. 25 The personality-function is the definition of oneself constructed in the body by the lived experience. About this, cf. G. Salonia (2012a), Theory of self and the liquid society. Rewriting the Personality-function in Gestalt Therapy, cit. 26 Cf. ibid. 27 Cf. G. Salonia (2012b), Il paradigma triadico della traità, cit.
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The Organism loses itself and does not manage to arrive in one piece, with its whole self, to the boundary of contact with the other
AD patients lose their autobiographic memory as well as the verbalnarrative-historical component of their identity
Patients lose the declarative, episodic and semantic access to this function, denying the intrapersonal dialogue
There is a detachment between the self (who I am) and the corporeal experience (what I feel): this determines the loss of the relational identity which, according to GT, is in the body in relation
Patients do not have an updated self-awareness in the here and now of the experience, but locate themselves in a spacetime dimension that is not the one of the shared Environment in the present, but the subjective one of the still accessible and remembered past
to the point «of not being able to call themselves by their first name»28. Their words are disconnected from the experience29: they lose the words of both world and body, the words to talk and to talk about themselves30. There is a detachment between the self (who I am) and the corporeal experience (what I feel): this determines the loss of the relational identity which, according to GT, is in the body in relation31. What we can observe is that patients do not have an updated self-awareness in the here and now of the experience, but we witness an existential reallocation, in which the patients locate themselves in a space-time dimension that is not the one of the shared Environment in the present, but the subjective one of the still accessible and remembered past. This phenomenon, ascribable to the degeneration of autobiographic memory, seems connected to the fact that thoughts of identity (who I am) and relation (who you are, what my surroundings are) are retraced by patients on the basis of their residual autobiographical and semantic knowledge. «One patient was settled back to when she was thirteen, so she thought she would still live with her parents and extended family, and had the typical worries of a teenager. She remained in the belonging context (she needs to look after the chickens otherwise her mum will scold) and in the historical, geographical and social one (she must hide from the Germans, she must turn off the lights if she hears the alarm of a car, which she identifies as signs of a bombing)»32.
28 B. Kimura (2005) (ed. or. 1992), Scritti di psicopatologia fenomenologica, Giovanni Fiorini, Firenze, 5. 29 Cf. G. Salonia (2012a), Theory of self and the liquid society. Rewriting the Personality-function in Gestalt Therapy, cit. 30 Cf. F.N. Gaspa, A. Nieddu (2010), Identità e Malattia di Alzheimer, cit. 31 Cf. G. Salonia (2008), La psicoterapia della Gestalt e il lavoro sul corpo. Per una rilettura del fitness, in S. Vero (ed.), Il corpo disabitato. Semiologia, fenomenologia e psicopatologia del fitness, Franco Angeli, Milan, 51-71. 32 L. Galantin (2004), La cura “dal guarire all’esserci”. Il modello della Psicoterapia della Gestalt nell’esperienza terapeutica con persone malate di Alzheimer, Tesi di Specializzazione della Scuola di Specializzazione in Gestalt Therapy, Istituto di Gestalt HCC Kairos, institute of Venice, 43-44.
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The story of Giovanna and her son shows how patients often settle back in moments of their life with unresolved – often painful and traumatic − situations33. In an unaware but functional way, what they remember best is the emotionally relevant information. Hence, when in the Environment something refers to an open gestalt34, the patients feel the emotion, the corresponding corporal-relational experience, but they are not able to contextualize it neither compared to the ‘here-and-now’ of the experience nor to specific events in the past. They often act in a way that is coherent to what they feel, but they are not aware of the underlying motivations and in line with the contingent situation. The Personality-function disorder is therefore affected by the difficulty of updating the Self through the assimilation of new experiences35.
Franco, the prankster Franco is a frail-looking old man with deep blue eyes, with a past as a bank manager, good social background and polite manners. The ward coordinator tells us that for some time Franco has been vexing the staff, because when they find his urine and faeces everywhere after he’s been to the restroom. Franco is self-sufficient in sphincter control and they absolutely do not want to interfere and perturb his privacy. The knowledge of the disease helps us: we suppose that Franco is no longer able to discern the colour white, which is the colour of all the bathroom facilities in the ward. We tried to paint the toilet seat blue, but to Franco it was like seeing something hovering in the air and it disoriented him. We then painted the whole toilet blue and he recognized it and said, “That’s one odd toilet, I might be old, but decorators these days…”. That put an end to the ‘mischief’.
33 Cf. ibid. 34 Cf. G. Salonia (2013a), L’anxiety come interruzione nella Gestalt Therapy, in G. Salonia, V. Conte, P. Argentino (eds.), Devo sapere subito se sono vivo, cit, 33-53. 35 Cf. G. Salonia (2012a), Theory of self and the liquid society, cit.
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Patients often settle back in moments of their life with unresolved – often painful and traumatic − situations
Perceptive deficits prevent from a correct perception of stimuli and, as a consequence, actions turn out to be inadequate
Contact episode interrupts because people suffering from AD lose their ability of symbolization
The orientation function is compromised
Franco’s story shows that perceptive deficits (agnosia, prosopagnosia, non-identification of some colours, such as white) often prevent from a correct perception of stimuli and, as a consequence, actions turn out to be inadequate. When the feeling emerges from the corporeal context, the contact episode36 interrupts because people suffering from AD lose their ability of symbolization37: they are no longer able to give a meaning to the stimuli according to a socially shared frame of reference and, furthermore, they have issues with relating their feelings and proprioceptions to the Environment. The orientation function38 is compromised: patients are no longer able to distinguish their need and thus to move towards the Environment, in order to fulfil it by putting in place functional choices. This process is confused: «a physical pain can acquire a linguistic form, in which the person repeatedly asks to go home; hunger manifests itself through the manipulation of an item; another person’s weeping can arouse the terrifying memory of screaming in a concentration camp; a doll can be held and looked after as if it was one’s own child; the bed is too big for someone who spent his/her life sleeping in a truck’s bunk»39. Cleaning assistants can be attacked because the patients lost their ability of judging and do not know they are supposed to wash themselves; they do not recognize the shower and they are scared of water and of what is happening. Hence, we can observe that the daily psychosocial functionality of AD patients is severely compromised, because they no longer perceive the Environment and their own interior world correctly, and cannot use their acquired competences anymore40. Without these backgrounds the process of identification/alienation that
36 Cf. G. Salonia (2013a), L’anxiety come interruzione nella Gestalt Therapy, cit. 37 Cf. L. Galantin (2004), La cura “dal guarire all’esserci”, cit. 38 Cf. G. Salonia (2013c), L’angoscia dell’agire tra eccitazione e trasgressione. La Gestalt Therapy e gli stili relazionali fobico-ossessivo-compulsivi, in G. Salonia, V. Conte, P. Argentino (eds.), Devo sapere subito se sono vivo, cit., 193-225; L. Galantin (2004), La cura “dal guarire all’esserci”, cit. 39 L. Galantin (2004), La cura “dal guarire all’esserci”, cit., 62. 40 Cf. ibid.
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characterizes the Ego-function of the Self41 is not fulfilled. AD patients are not capable of identifying/alienating parts of the field to choose what they consider appropriate and to organize their behaviours in an adaptive and creative way42. Furthermore, unacknowledged stimuli determine anxiety and catastrophic reactions that turn into agitated behaviour43.
Giovanni, the famished Giovanni is an old man aged 77, almost two meters tall, solidly built; he used to be a bricklayer, but stopped a few years ago, when the disease arose. According to the ward personnel, Giovanni, who is a sweet and polite man, lately has been behaving very aggressively, especially after the main meals. “…he screams, stands up from the table, doesn’t finish the food on his plate, shouts at the other patients, says that they steal his food, that he has always less than the others even though his food is still on his plate… we don’t understand… and calming him down isn’t easy. In the end, the nurses had to sedate him…”. After having observed Giovanni for a few days, we noticed that he only ate the food on the right side of his plate, and then stood up enraged and repeated the scene described by the personnel. The right side and not the left… why?
41 The Ego-function of the Self can be described as the ability of choosing what is considered appropriate by inventing a ‘third solution’ in harmony both with the physical experience of the here and now (Es-function) and with the knowledge learned in the past (Personality-function) in order to use the ability of ‘creatively adapting’ to the field. Cf. G. Salonia (2012a), Theory of self and the liquid society, cit. 42 The patient’s Self cannot choose, through the Ego-function, what it deems appropriate because of the malfunction of the Es-function (perceptive deficits) and of the Personality-function (memory deficits). Cf. G. Salonia, A. Sichera (2014), Tempi e modi della Funzione-Io, Yearly GTK Meeting, Ragusa 30-31 May/1 June 2014; G. Salonia, A. Sichera (2015), Rilettura delle funzioni del sé: quali nuovi sviluppi teorici e clinici in Gestalt therapy, Yearly GTK Meeting, Venice 3-4-5 July 2015. 43 Cf. AA.VV. (2013), “Non so cosa avrei fatto oggi senza di te”, cit.
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AD patients are not capable to choose what they consider appropriate and to organize their behaviours in an adaptive and creative way
Furthermore, unacknowledged stimuli determine anxiety and catastrophic reactions that turn into agitated behaviour
It is known that the Alzheimer’s disease often includes sight problems, among them, sight scotomas that concern extended areas of the visual field. Could Giovanni, then, have not been able to see the food on the left side of his plate? We tried to see what happened if a staff member sat next to him. As soon as Giovanni would finish the food he was able to see, the staff member would turn the plate, in order to make him find some more food, without having the feeling that he was treated different than the other patients. The solution worked. Giovanni’s story shows that some dysfunctional behaviours carried out by the patients, which the literature defines as «noncognitive symptoms» or psychiatric disorders, could be traced back to an altered reconstruction of reality, since the patients do not have enough cognitive resources to carry out an accurate analysis, to adequately identify feelings and to comprehend what is their actual discomfort and its source44.
Guido, the sensitive Guido is an old friar with a moderate state of Alzheimer’s. He spends his days in the convent. The friars he lives with an who take care of him, involve him in some activities. One day, the superior sees him standing aside with a worried face, looking very sad, as if he was disheartened. Having already been informed that there were some misunderstandings between Guido and another brother, he approaches him, trying to interact with him and understand how he is feeling and if he needs something. To the questions of the superior, who is trying to understand what happened and what hurt him, Guido replies, “I don’t know what he said to me, but he was angry!”.
44 Cf. M. Boccardi (2002), La riabilitazione cognitiva e comportamentale nella demenza: un approccio pratico per le R.S.A., cit.
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Guido’s story proves that AD patients can still access the corporeal dimension of knowledge45. Referring to the ‘mirroring’ mechanisms46 we can suppose that the same nervous structures that allow the patients to experience their own perceptions and feelings also allow them, an implicit understanding of other people through the activation of an ‘intentional consonance’. As a matter of fact, this resonance mechanism, as an intercorporeal link, allows to «‘map’ the feelings and the actions of other people in a pre-linguistic, pre-rational, non-introspective, direct and automatic way»47 (translated by the author). We know that reality is known through different corporeal and propositional representational formats. What we can observe in AD patients is the progressive inaccessibility to the propositional format and the permanence of the corporeal one. It is as if, in a process of progressive deterioration, the corporeal representational system was maintained, which, on a phylogenetic and ontogenetic level, precedes the propositional one. In clinical terms, this implies that sensations and emotions remain in patients as anchors48 to reality, both in subjective and intercorporeal terms, determining their way of being in the world and their relationships with others. In the light of the different stories, we can state that the experience of AD patients, and therefore the deploying of the Self to the boundary of contact, is interrupted because there is a disturbance in the unfolding of the experience, as the background, at first confused and then increasingly fragmented, does not allow a clear and define surfacing of the figure that guides the Organism towards a new contact with the Environment49.
45 Cf. V. Gallese (2013), Corpo non mente. Le neuroscienze cognitive e la genesi di soggettività e intersoggettività, in «Educazione Sentimentale», 8-24. 46 Cf. ibid. 47 V. Gallese (2010), Le basi neurofisiologiche dell’intersoggettività, in «La società degli individui», 37/1, 48-53, 51. 48 This clinic clarification was made by Prof. Giovanni Salonia. 49 Cf. A. Sichera (2013), Dalla frattura freudiana alla continuità gestaltica: lo scarto epistemologico di Gestalt Therapy, cit.
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AD patients can still access the corporeal dimension of knowledge. Referring to the ‘mirroring’ mechanisms we can suppose an implicit understanding of other people through the activation of an ‘intentional consonance’
Sensations and emotions remain in patients as anchors to reality, both in subjective and intercorporeal terms
Patients lose their competence of contact in terms of entirety first and then in those of integrity; one can assist to a progressive decline of the form of intrapersonal on-between, and subsequently of subjectivity
However, even though not fully aware, the patient’s body still carries within itself its implicit corporeal memory and the relational intentionality
The Alzheimer’s Disease it erodes the wefts that put together the neurological and relational fabric, killing their connections and fragmenting the meeting space, as the immediate intelligibility of the shared background fails. from this corporeal on-between, treatment must begin
The patients gradually lose the ability of feeling that they are there and that they are present50 at the boundary of contact, with entirety and integrity51. The neurological decline of AD patients determines a regression that seems to trace the evolutionary steps in reverse, which allowed the surfacing of contact competence and subjectivity. Patients lose their competence of contact in terms of entirety first and then in those of integrity; one can assist to a progressive decline of the form of intrapersonal on-between, and subsequently of subjectivity52. The Self loses itself: the patient’s body loses its soul because it loses the possibility of feeling the fullness offered to the Organism in full contact with the Environment53. However, even though not fully aware, the patient’s body still carries within itself its implicit corporeal memory54 and the relational intentionality, and moves it in its being-there in the world and among others.
Some coordinates of clinical approaches The Alzheimer’s Disease is an erosive illness: it erodes the wefts that put together the neurological and relational fabric, killing their connections and fragmenting the meeting space, as the immediate intelligibility of the shared background fails. And it is precisely from this meeting space, from this corporeal on-between, that treatment must begin, going towards the patient with the wilfulness to co-build the boundary of contact, «embracing
50 Cf. F.N. Gaspa, A. Nieddu (2010), Identità e Malattia di Alzheimer, cit. 51 Cf. G. Salonia (2008), La Psicoterapia della Gestalt e il lavoro sul corpo, cit. 52 This is coherent with the neurobiological data: recent studied, in fact, consider the Alzheimer’s Disease as a systemic pathology, that traces in reverse the stages of cerebral myelinogenesis, concerning the temporal areas in the initial phase and, progressively, the entire brain. Cf. C. Colosimo (2013), Neuroradiologia, cit. 53 Cf. G. Salonia (2012b), Il paradigma triadico della traità, cit. 54 The implicit modality is preserved in every memory function, unlike the explicit one. Cf. M. Boccardi (2002), La riabilitazione cognitiva e comportamentale nella demenza: un approccio pratico per le R.S.A., cit.
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the challenge of meeting them where they stand»55 (translated by the author). Lucia is singing her usual song in the hallway staring at the white wall in front of her, as if it was a big audience; Gino yells, “It’s mine, it’s mine… give it back!” and breathlessly tries to chase after a retreating relative. Wanda approaches you, scared, sweaty, struggling to breathe, takes your arm and says, “Miss, Miss, I got lost… can you bring me home?”. Giovanni gives you a threatening stare and keeps quiet, but you know he could hit you at any time. Maria approaches you and with a big smile and says, “I’m still young and attractive, desirous… I am half-minded to place an ad on the newspaper and find a husband…”. A typical experience of an encounter at the boundary of contact with AD patients is the feeling of indefiniteness, unpredictability and precariousness. «Of the person approaching you not knowing where she is, what she is going through, which unfinished events she is dealing with, what are her current needs, finding herself in the tragic impossibility of communicating them even if she was aware of them»56 (translated by the author). We are confronted with a body that expresses itself beyond awareness, with a lost identity and with the elusiveness of subjective experience. Assuming the centrality of the body as the interaction space between Organism and Environment, of memory and intentionality of contact in the encounter leads, according to the Gestalt Therapy, the attempts to relate to AD patients and offers clear coordinates to clinical approaches. Taking care of an AD patient means creating the conditions to activate a healthy confluence where the Environment has to become nourishing, as it supports valid and functional contacts. The aim is to approach patients, managing to make them fully express the contact by providing adequate support. In fact, the deterioration of the contact functions leads to the fact that the
55 L. Galantin (2004), La cura “dal guarire all’esserci”, cit., 20. 56 Ibid., 39.
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A typical experience of an encounter at the boundary of contact with AD patients is the feeling of indefiniteness, unpredictability and precariousness
Assuming the centrality of the body as the interaction space between Organism and Environment, of memory and intentionality of contact in the encounter leads, the attempts to relate to AD patients and offers clear coordinates to clinical approaches
The therapeutic work aims at creating a protesic Environment that supports the patient’s Self in the evolving of this pathology
Those who take care of the ill need to be able to restore an ‘auxiliary’ Personality-function and to observe the patients’ problematic behaviour that emerges at the boundary of contact here and now
patients gradually «are no longer able to fluidly adapt to their world»57 (translated by the author) and therefore to carry out contacts that are functional to their own survival. Therefore, the therapeutic work aims at creating a protesic Environment58 that supports, in the minimum necessary way59, the patient’s Self in the evolving of this pathology60. Reinterpreting the patients’ dysfunctional behaviours in light of the specific functional deficits and of the temporal relocation can make them understandable. The care providers can therefore, through their knowledge of the disease and of the personal and family history of the patients61, retrieve part of the shared background and thus try to give meaning to their past, to contextualize some of their actions, to understand what they need by following and exploring their intentionality of contact62. Those who take care of the ill need to be able to restore an ‘auxiliary’ Personality-function and to observe the patients’ problematic behaviour that emerges at the boundary of contact here and now to recognize and understand (here the healthy confluence) their needs of the moment. In Giovanna’s story, for example, reinterpreting her spits and aggression against her son in light of the Personality-function disorder was an effective step that allowed to give a meaning to the patient’s actions, mending once again a weft with her identity63, which allowed the contact, besides the momentary resolution of the symptomatic behaviour.
57 J.I. Kepner (1997), Body process. Il lavoro con il corpo in psicoterapia, Franco Angeli, Milan, 40. 58 The definition of ‘protesic’ Environment shows that when the Organism loses its adaptive abilities to the Environment, the Environment itself must be the one to adapt to the Organism in order to perform a missing of heavily deficient function, as if it was indeed its prosthesis. Cf. M. Boccardi (2002), La riabilitazione cognitiva e comportamentale nella demenza: un approccio pratico per le R.S.A., cit. 59 The care provider’s behavior needs to be protesic only in the functions the patient is really unable to perform. Cf. ibid. 60 Cf. L. Galantin (2004), La cura “dal guarire all’esserci”, cit. 61 Cf. S. Brambilla (2014), Sguardo sull’Alzheimer, in «Dialoghi Adleriani», 1, 2, 108-117. 62 Cf. L. Galantin (2004), La cura “dal guarire all’esserci”, cit. 63 Cf. S. Garolfi, S. Lerda (2013), L’identità oltre i ricordi perduti: la demenza di Alzheimer, in «Rivista di Psicologia Individuale», 74, 69-95.
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It is important to underline that the care providers’ knowledge of the patient’s history needs to be detailed, as details (hair, smells, sounds, the colour of their clothes, physical contact, etc.) awaken memory residues in the patient, facilitating the implicit recollection of memories as associative or procedural memory. As it was shown in the different stories, an accurate and contextualized observation of the patients’ behaviours is necessary to comprehend their meaning and intentionality64 and to find adaptive solutions. For example, the strategy of simplification on the perceptive field, put in place in the story of Franco ‘the prankster’, allowed the patient to reconnect his need to the environmental availabilities and therefore to adopt an adequate behaviour. It is important to underline that among the countless fragmented behaviours of the patient, only one is expression of their intentionality, so the care provider needs to be able to identify this ‘clumsy movement towards’ and latch onto it, helping the patient to offer both meaning and direction. Luigi is a former barman. When dinner time approaches, he begins to stress out, moving in the room without purpose, touching different items of the ward’s recreational room: he smells them, moves them, puts them down, picks them up again. He approaches other seated patients, stares at them, touches them, moves away, stops, comes back and starts pushing them and mumbling something incomprehensible, then cuts himself short, moves towards the empty chairs and starts to put them on the table. At this point, the orderly understands and calmly says, “You’re right, Luigi, let’s start to tidy up and get ready for dinner”. To do so, those who take care of patients have to be able to use all the available information in the field65. Similar to what happened in the story of Giovanni ‘the famished’, though the information of the field, one can be able to make a good synthesis of all the acquired elements and find a solution to the contact
64 Cf. A. Filiberti, P. Zeppegno (2013), Identità, senso di sé e demenza, in A. Monteleone, A. Filiberti, P. Zeppegno (eds.), Le demenze: mente, persona, società, Maggioli, Santarcangelo di Romagna, 81-93. 65 Cf. L. Galantin (2004), La cura “dal guarire all’esserci”, cit.
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The care providers’ knowledge of the patient’s history needs to be detailed, as details (hair, smells, sounds, the colour of their clothes, physical contact, etc.) awaken memory residues in the patient
Among the countless fragmented behaviours of the patient, only one is expression of their intentionality, so the care provider needs to be able to identify this ‘clumsy movement towards’ and latch onto it, helping the patient to offer both meaning and direction
The therapeutic intentionality aims at supporting the deficient functions of the Self, connecting the figure to its background, mending lost wefts
(finally!). It means to put an end to the dysfunctional behaviour of the patients by appeasing their anxieties, which is what they are not able to do on their own. The therapeutic intentionality aims at supporting the deficient functions of the Self to allow patients to have contact with the Environment and thus to fulfil their needs, connecting the figure to its background, mending lost wefts. In the therapy relation with AD patient it is therefore necessary that an I capable of intrapersonal on-between takes care of a Thou where this on-between is losing its shape66 to support the increasingly fragmented relation with itself. With the progress of the disease, the patient loses autonomy, so therapy needs to be oriented towards an increased environmental support through specific strategies.
66 Cf. G. Salonia (2013b), L’esserci tra. Aida e confine di contatto in Bin Kimura e Gestalt Therapy, cit.
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Andreoli V. (2015), La demenza di Alzheimer, http://anchise.net/2015/04/14/la-demenza-di-alzheimer/.
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Abstract The article aims at reinterpreting the neuropsychological and behavioural decline typical of Alzheimer’s Disease (AD) as a gradual fragmentation process of interpersonal and intrapersonal on-betweens, identifying a possible therapeutic approach. Starting from some clinical cases, the article traces a phenomenological reinterpretation of AD through the hermeneutic and clinical application of the Theory of the Self and of the Theory of Contact. Hence, it verifies how neurological deterioration compromises the dynamism of the interpersonal background/figure on-between and how the progressive loss of form of the intrapersonal on-between happens. Finally, it identifies what remains as strong point in the patient: implicit corporeal memory and relational intentionality. On the basis of these acquisitions, the article identifies the essence of therapeutic work as the creation of a protesic Environment that offers to the patient a minimum necessary support in the progress of this disease and it suggests a precise clinical approach, whose efficacy has been experimented in a few contexts of communal therapy. The creation of a therapy context able to support the contact with the Environment in AD patients, and therefore the fulfillment of their needs, seems to be a possible path of intervention, ethical in the therapeutic intentionality of mending lost wefts.
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Sky and earth
RESEARCH
THE HEART OF CO-PARENTING IN GESTALT THERAPY INTERVIEW WITH VALERIA CONTE AND GIOVANNI SALONIA by Aluette Merenda Aluette I would like to start asking you to conceptualise Co-parenting according to the perspective of Gestalt Therapy. Several American researchers conceive it as a curvy and bumpy road, which implies a hard challenge in being a in cooperation with the other parental partner. In your opinion, is it a developmental challenge or the discovery of a ‘gift’ for children and their families?
According to Gestalt Therapy, it could be defined as “Personalityfunction-of-beingparents”
Nowadays, both parents are copresent at home as well as in the polis and the tasks overlap on a register of joint collaboration: we would call it a ‘horizontal’ coparenting, which is unexperienced and therefore has to be invented and verified from time to time
Giovanni First of all, let’s clarify some things. What does co-parenting mean? According to Gestalt Therapy, it could be defined as “Personality-function-of-being-parents”. It’s a matter of fact. The question: «Who is my father?» is part of the human condition. Before post modernity, co-parenting was taken for granted: father in the polis, mother at home. It was the only possible status, because wars and indigence required men to be away from home, while women were not independent from an economical and professional point of view and therefore had to stay home. Before post modernity, for example during the industrial revolution, even if women could have a job outside their homes, they still had to deal all alone with the education of their children. One used to take care of the protection and security of the family, the other of the growth and education of the offspring: parallel and functional tasks. Nowadays, both parents are copresent at home as well as in the polis and the tasks overlap on a register of joint collaboration: we would call it a ‘horizontal’ co-parenting, which is unexperienced and therefore has to be invented and verified from time to time. We are not prepared for this new relationship and we are not always aware that the relationship parents have with each other is decisive for their children: in many situations of separation, children end up undergoing undue triangulation: parents ally with one or more children against the other parent.
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It is a challenge inasmuch new discovery, but certainly a gift because it allows us to experience more fulfilling relationships and brighter personal conditions. Valeria We know it, but today, more than ever, we have to realize that the well-being of children is in any case co-built by the parental couple: being a good father or a good mother is not possible without the other parent1. If the adult looks at the child only, he/she has a partial vision. It’s important to have a look at the relation of the father-mother-child triad to understand educational factors and distress. Otherwise, each educational answer could be incomplete and often useless. Feeling that one is part of the primary triangle is a great resource that coparenting offers us2. From Elisabeth Fivaz-Depeursinge and the group of Lausanne3 with LTP we know − thanks to the observation of interactive behaviours within the primary triangle − that at an early age the child (C.) is able to play triadic, i.e. playing with both co-parents. These aspects were analysed in details by Salonia in his developmental theory in Gestalt Therapy4, wondering how it is possible for GT to observe the primary triangle, being faithful to the relational phenomenological matrix and to the attention of body and experience. GT observes the corporeal-relational experiences that are continuously woven between the members of the primary triangle. Research has been carried out in this direction by recording the triadic play of children aged between 18 and 24 months, and through
1 Cf. G. Salonia (2009), Letter to a young Gestalt therapist for a Gestalt therapy approach to family therapy, in «The British Gestalt Journal», 18, 2, 38-47. 2 Cf. J.P. McHale (2010), La sfida della cogenitorialità, Raffaello Cortina, Milan. 3 Cf. E. Fivaz-Depeursinge, A. Corboz-Warnery (2000), Il triangolo primario, Raffaello Cortina, Milan. 4 Cf. G. Salonia (2013a), Edipo dopo Freud. Dalla legge del padre alla legge della relazione, in G. Salonia, A. Sichera, Edipo dopo Freud, GTK-books/1, Ragusa, 11-46; G. Salonia (2014), Psicoterapia della Gestalt e teorie evolutive, in G. Francesetti, M. Gecele, J. Roubal (eds.), La psicoterapia della Gestalt nella pratica clinica. Dalla psicopatologia all’estetica del contatto, Franco Angeli, Milan, 259-275.
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The well-being of children is in any case co-built by the parental couple: being a good father or a good mother is not possible without the other parent
Feeling that one is part of the primary triangle is a great resource that coparenting offers us
Combine the affection for one’s children with emotional vicinity often is a source of distress, uncertainty and sense of inadequacy: being a parent nowadays doesn’t mean that you only have a role to play; you should be able to fully and spontaneously experience this role
Clarifying and dealing with the topic of Co-parenting includes an anthropological, clinical and as well as epistemological turning point
the observation of the experience that occurs at the contact border in the interaction of father/mother/child. The interviews and questionnaire that accompanied the video gave interesting ideas of how every experience between father and mother can influence each single dyad. I remember with surprise how a mother, who saw her parent partner playing with their son, seemed quite upset and showed intolerance and annoyance towards her husband. She put her feelings into words, stating that her partner would never play with their son and thus she was very annoyed, as she thought he was doing it just to look like a caring father. On the other hand, her husband replied: «Every time I want to play with the C. you step in between, in order to make him do something, or you want to clean or feed him…». It’s obvious that we are not surprised by the fact that the C. continuously looks at his mum while playing with his dad, as if he would wait for something. Co-parenting surely is a challenge of post-modern parenting. Even if parenting is more and more defined and is about a rather conscious and wanted experience nowadays, the choice of becoming a parent includes fears. On one hand, there is fear of a bond that lasts ‘forever’, which is perceived as permanent – indeed, you can break up with your partner, but not with your children. On the other hand, there if fear of not being able to living up to, since the load of educational responsibility is very heavy. Combine the affection for one’s children with emotional vicinity often is a source of distress, uncertainty and sense of inadequacy: being a parent nowadays doesn’t mean that you only have a role to play; you should be able to fully and spontaneously experience this role.
Aluette Clarifying and dealing with the topic of Co-parenting includes an anthropological, clinical and as well as epistemological turning point. Such turning point is connected to the understanding of child development, of the different ways of being together and, last but not least, of the human condition. Do you think that there is a connection to the social changes of post-modernity?
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Valeria If we look at the Western post-modern context without wistfulness towards the past, we spot lots of resources and potentialities. In fact, relationships are being rediscovered, which to some extent also includes an unprecedented trust in relationality, seen as an experience of contact between people. One of the challenges people and partners have experienced in the last twenty years is the possibility of experiencing equal relationships, on the register of true equality5 in both intimate (couple or family) and social (work, friendship) contexts. Today we can say that peer relationships are enriched by the possibility of full freedom of expression differences, which is not obvious yet, but in progress. The primacy of subjectivity, self-affirmation and the value given by experience, allowed us to make a qualitative step with interpersonal relationships on one hand and became the actual expression of discomfort and limit of peer relationships on the other hand. Couple relationships are certainly one of the places where diversity is not only present, but necessary, in my opinion. Diversity forces to relationships, to dialogue, to an open communication showing interest towards the other. The comparison with the other, as being the other compared to oneself, becomes a great resource that will allow differences to express themselves by reducing the individualistic and omnipotent drives, and brings us back to the relationship − the only place where subjectivity can reach its fullness. Giovanni Without any doubt. The presence of women in the polis and men at home represent an anthropological turning point with long-term consequences. Men experience sensitivity they had never felt before and women express the organizational potentialities and wisdoms, of whose deficiency the previous civilizations surely suffered. The loneliness of the global world opens up the horizons and directs towards an incessant research for
5 Cf. L. Irigaray (1994), La democrazia comincia a due, Bollati Boringhieri, Turin.
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One of the challenges people and partners have experienced in the last twenty years is the possibility of experiencing equal relationships, on the register of true equality in both intimate (couple or family) and social (work, friendship) contexts
Couple relationships are certainly one of the places where diversity is not only present, but necessary, in my opinion
One could suppose that a positive co-parenting will make the cohabitation between humans and the relationship with diversities more liveable and positive
Personally, I am very perplexed about homosexual parents adopting children aged between zero and seven/nine years, since that’s the moment when the corporeal identity is formed and levelled off
the other, who – we know it now − is not ‘other compared to me’ but, to say it with Gadamer’s6 words, is ‘the other of myself’ and also ‘beyond myself’. The experience is always different. Attention to the other, awareness of one’s own experiences, creativity all lead the dance of encounters. The child is just an ‘other’; he used to be unknown or otherwise underestimated and ignored: therefore− you say it − new horizons are placed even from an epistemological viewpoint. We will see the undoubted advantages of these paths very slowly. Now − being at the beginning − we can maybe see more of the efforts. One could suppose that a positive co-parenting will make the cohabitation between humans and the relationship with diversities more liveable and positive.
Aluette Following the footsteps of this turning point, connected to the understanding of human condition in the post-modern context and to the experience of consciously crossing the dance of encounter with diversity, I would like to ask how to conceive co-parenting in the current scenarios of cohabitation. For example, in homosexual couples, where the topic of homosexual (co)parenting opens ones’ mind to new treatment models, to educational thoughts and, inevitably, to problematic aspects. Giovanni Expressing oneself about homo-parenting is not easy, as it is a recent topic with many anthropological values. Even research − as we known − does not solve this issue because it includes various and complex variables, and data are still not sufficient enough for an objective evaluation. Personally, I am very perplexed about homosexual parents adopting children aged between zero and seven/nine years, since that’s the moment when the corporeal identity is formed and levelled off. My long training in body therapy and GT, my almost forty years of
6 Cf. H.G. Gadamer (1983) (ed. or. 1960), Verità e metodo, Bompiani, Milan.
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clinical experience, Neuroscience studies (think of Damasio’s7 “autobiographical Self”, the Embodied Cognition) lead me to think that the child builds up (or I could better say, he ‘cobuilds’) a healthy body identity in the interactions between his own body and his parents’ body (primary intercorporeity): he learns that he has and is ‘this’ body only within the ‘aesthetic’ relationship (in the Greek sense of the term: with all senses) with his parents’ bodies. Being touched and touching (think of recent studies on ‘atypical perception’ in its cognitive, motoric and sensory declinations), being seen and being able to see the bodies and exploring them are essential experiences in the construction of a body identity or implicit body patterns. Parental relationship is therefore not only affective but also definitely corporeal. Therefore, I believe that growing up while interacting with two ‘parental figures’ (a nice description compared to the cold word caregivers) of the same sex heavily penalizes the development of children’s body identity. Obviously, my perplexity has absolutely nothing to do with the parental skills of each parent (which for me is obvious). Since it’s a new topic, I am open to further analysis.
Aluette Taking into consideration the current family types that characterise post-modern society, how (and if) is it possible to continue playing a co-parenting role, when parents are no longer married? Valeria Not stopping of being parents even when a relationship ends is certainly a challenge of post-modern parenthood. Families change, turn into different structures. Partners open up to new relationships, new families are formed, but it is possible, and maybe necessary, to maintain a good/sufficient parenthood. One still remains a parent and still has the responsibility of not adding damage to the physiological suffering that the end of
7 Cf. A. Damasio (2012), Il Sé viene alla mente. La costruzione del cervello cosciente, Adelphi, Milan.
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The child learns that he has and is ‘this’ body only within the ‘aesthetic’ relationship (in the Greek sense of the term: with all senses) with his parents’ bodies.
I believe that growing up while interacting with two ‘parental figures’ (a nice description compared to the cold word caregivers) of the same sex heavily penalizes the development of children’s body identity
Not stopping of being parents even when a relationship ends is certainly a challenge of post-modern parenthood
Separation is not unsustainable suffering if parents give their children the time to suffer and adapt to changes, which, as we know, also include concrete choices, acquired habits, and new and familiar spaces and homes
Children don’t care if mum and dad are perfect, but rather that they are able to protect them without requesting exclusive alliances against the other parent
the family, inevitably, entails for children. One day a couple in the process of being separated asked for psychotherapeutic intervention: «We mutually agreed on this separation, but we don’t want our children to suffer, and we think that it would help if they are supported by professionals, psychologists, wouldn’t it?». It is clear they asked a non-quite-correct question, since it seems denying the physiological pain of children for their parents’ separation. Sometimes, looking for external and professional advice and solutions is a way to avoid responsibility for ones’ own choices, so to not having time for displeasure or suffering that the end of the family inevitably entails for children. Separation is not unsustainable suffering if parents give their children the time to suffer and adapt to changes, which, as we know, also include concrete choices, acquired habits, and new and familiar spaces and homes. We have a completely different scenario when a couple is about to split up, but still lives the end of the relationship, with high conflict and fighting against each other. Children don’t care if mum and dad are perfect, but rather that they are able to protect them without requesting exclusive alliances against the other parent, even if this is not obvious for parents and sometimes becomes an arrival more than a starting point. The conflict generated by the struggle for power − to win over the other − or by the search for truth − who is right and who is wrong − is incurable and sterile. Children can’t split and the division only fosters suffering. Feelings such as anger, revenge, vendetta belong to the married couple, which has to find individual spaces or, when possible, a mediation towards parenthood, in order to be able to separate the pending experiences as a married couple from the parental function. Giovanni First of all, let’s specify that the relationship of a married couple is equal, including an agreement, and is oriented towards personal and mutual well-being. The parents/children relationship is not equal and has not been chosen by children: it is indispensable and primarily intended for a unilateral well-being (children neither have to make their parents happy nor solve their problems), even if parents grow as well and are enriched by the relationship with their children. These two kinds of relationship follow different paths. Hence, while the marital relation-
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ship may finish, the parental one never does. As I confronted myself with to Kimura, I learned to define parents/children relationship as an “archi-on-between”, because it’s the base of all other interpersonal and intrapersonal relationships8. Parental responsibility certainly includes taking on the weight of inevitable suffering of children when parents split up, as well as the wisdom of not involving children in a couple’s quarrel that do not belong to them, and the possibility of continuing to be affectionate and caring parents even if separated. In GT, the ability of being positive parents is part of the Personality-function, and behaviours (or experience, to say it worse) that are not oriented in this direction are ascribed to the disorder of such function of the Self9. The problem is not the presence of conflicts, but the non-developed ability to manage them.
Aluette In situations of highly conflictual marital separation, the difficulty in managing conflict may represent a critical element that loses its evolutional matrix, blocking on regressive (destructive) aspects. Taking also into account the legislative indications (Law 54/2006) that privilege a shared custody and bi-parenting, do you believe that sharing parenthood with the ex-partner is still the most appropriate caring strategy for children in such relational contexts? Valeria Co-parenting is necessary even if sometimes really difficult, especially with two parents who split up and with high levels of conflict. Bringing out the mindfulness that one always remains parents-with even when the ex-partner lives strong feelings of hatred, revenge, retaliation, is not easy. Sometimes, in conflict situations, the split and irreconcilable positions of parents risk
8 Cf. G. Salonia (2013), L’esser-ci-tra. Aida e confine di contatto in Bin Kimura e in Gestalt Therapy, in B. Kimura, Tra. Per una fenomenologia dell’incontro, Il Pozzo di Giacobbe, Trapani, 5-20. 9 Cf. G. Salonia (2012), Theory of self and the liquid society. Rewriting the Personality-function in Gestalt Therapy, in «GTK Journal of Psychotherapy», 3, 29-57.
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In GT, the ability of being positive parents is part of the Personalityfunction, and behaviours (or experience, to say it worse) that are not oriented in this direction are ascribed to the disorder of such function of the Self
Bringing out the mindfulness that one always remains parents-with even when the expartner lives strong feelings of hatred, revenge, retaliation, is not easy
Under these circumstances, the best way to make co-parenting possible is – paradoxically − giving up to be a parent-with
The recovery of the parental function of mother and father is possible only by coming out of the logic of agreeing, isolating the conflict within the couple and leaving out the maternity and paternity
According to GT vision, living one’s own parenthood completely means to combine and integrate ‘what I feel’ − affection, closeness, insecurity/security, inadequacy/ adequacy − with the question: «Who am I for feeling like this?» − father/ mother, man/woman, husband/wife
to foment non-spontaneous behaviours in children. Confused experiences and requests for exclusive alliances against the other parent are continuous wounds for children. Under these circumstances, the best way to make co-parenting possible is – paradoxically − giving up to be a parent-with. Here’s an example: in a therapy session, two separated parents tell about how they hard it is for them to cope with the incessant calls to the ex-partner that is fostering the child at that moment. They were very rigid people, apparently different but similar in the continuous calls to have an update on the child (Is he sleeping? Is he playing? Is he doing fine? Did he eat?) or even to check and possibly correct the educational skill of the ex. Each parent has indeed the feeling to be ‘the best’ and, as a consequence, not totally trusting the other. The ‘parental’ relationship got smoother when they created a border between them: when the child would be with one parent, the other should call neither the child nor the parent. In other words, being father and mother alone. In these cases, the recovery of the parental function of mother and father is possible only by coming out of the logic of agreeing, isolating the conflict within the couple and leaving out the maternity and paternity. The mother explained the effectiveness of this new agreement with a smile: «It’s actually true: I feel like I’m not able to be with my son alone, I always feel that his father might call at any time, and I feel wrong and not natural». In these situations, there is the risk of being influenced − in a determined but inappropriate way − in intimate and deep experiences, and losing the experience of always and in any case being a mother/father of a child.
Aluette According to GT, how is the sense of co-parenting related to the functions of the Self, and in particular to the Personality-function (of the family Self)? Valeria According to GT vision, living one’s own parenthood completely means to combine and integrate ‘what I feel’ − affection, closeness, insecurity/security, inadequacy/adequacy (Id-function of the Self, which focuses on corporeal feelings coming
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from ‘under the skin’10) − with the question: «Who am I for feeling like this?» − father/mother, man/woman, husband/ wife (Personality-function of the Self, or better, the assumption of what the individual is, the responsible structure of the Self11). It’s useful to combine spontaneity and knowledge, let yourself be guided by experience in its entirety, feel and − at the same time − understand that you are the father or mother of this child. Indeed, being a parent is something unique that belongs primarily to your body and only later becomes (correct) thought, (exact) word, (adequate) behaviour12. Growth needs two perspectives and an educational style that is neither split nor incompatible. If there is respect and gratitude for the other parent’s thinking, any solution will be highly educational13. To make this possible, one has to be able to have faith in one’s own and the others’ parental function, and think that by listening to their children and looking at their needs, it is possible to ensure an adequate and functional growth for them. Giovanni The co-parenting relationship ‘belongs’ to the child, who feels his parent’s relationship in his being taken care of. The son feels if the parent perceives himself as a parent-of or parentwith, and if he does not get the certainty that his parents know they are parents-with, he somehow absorbs the consequences
10 Cf. G. Salonia, V. Conte, P. Argentino (2013), Devo sapere subito se sono vivo. Saggi di psicopatologia gestaltica, Il Pozzo di Giacobbe, Trapani; Cf. G. Salonia (2012), Theory of self and the liquid society. Rewriting the Personality-function in Gestalt Therapy, cit. 11 Cf. F. Perls, R. Hefferline, P. Goodman (1994) (or. ed. 1951), Gestalt Therapy: Excitement and Growth in the Human Personality, The Gestalt Journal Press, New York; A. Sichera (2012), The Personality-function in Gestalt Therapy, in «GTK Journal of Psychotherapy», 3, 17-27. 12 Cf. G. Salonia (2008), La psicoterapia della Gestalt e il lavoro sul corpo. Per una rilettura del fitness, in S. Vero, Il corpo disabitato. Semiologia, fenomenologia e psicopatologia del fitness, Franco Angeli, Milan, 51-71; Cf. G. Salonia (2012), Theory of self and the liquid society. Rewriting the Personality-function in Gestalt Therapy, cit. 13 Cf. G. Salonia (2009), Letter to a young gestalt therapist for a gestalt therapy approach to family therapy, cit.
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Growth needs two perspectives and an educational style that is neither split nor incompatible. If there is respect and gratitude for the other parent’s thinking, any solution will be highly educational
The son feels if the parent perceives himself as a parentof or parent-with, and if he does not get the certainty that his parents know they are parentswith, he somehow absorbs the consequences of their splitting
It is the motherfather relationship that regulates the ordo amoris of the primary triangle: there are no situations of too much love, but situations of badly ordered love where there is confusion between roles
Parenthood is certainly influenced by the relational experience with the partner
of their splitting14. I would like to emphasize that the split, this dysfunction, is always of parents, not of children. Freud’s or Lacan’s theories have been extensively reinterpreted: the family Self is constituted not only by the way parents perceive their relationship with their child, but above all by how the relationship of the other parent works with that child. In fact, it is called primary triangle. It’s not a cognitive question, but a feeling within one’s body, on the level of corporeal experiences (Damasio’s ‘autobiographical self’ we already mentioned), the fact of actually being parents and part of a functioning triangle (the Personality function is always corporeal). It is the mother-father relationship (once it was thought that everything depended on the father, today luckily, we went beyond this thought) that regulates the ordo amoris of the primary triangle: there are no situations of too much love, but situations of badly ordered love where there is confusion between roles. And the situation of order or dis-order is given by the co-parents’ relationship: the ordo carnis first of all, from which the ordo amoris comes from.
Aluette It seems that being a parent makes it impossible not to be influenced by the relational experience with the partner. In your opinion, starting from the paradigm of co-parenting, can couple relationships in the first instance and parental ones subsequently be or become more functional for the growth of children? Valeria Parenthood is certainly influenced by the relational experience with the partner. The awareness of the undeniable influence the marital relationship has on co-parenting is already an important step to open up to questions without requesting quick answers, to recover the humility to learn new and more functional ways for the couple, and therefore to the parental function, which is effectively influenced by conjugality.
14 Cf. ibid.
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Often, couples ask for help because despite being united by a strong feeling, their daily life becomes unbearable15. The partners are indeed not able communicate and the other’s way thinking seems incomprehensible. The feeling that there are two completely different and irreconcilable logics is very recurring. Clearly, all this is amplified by talking about the educational aspects related to their growing children: making decisions together, sharing choices, rules, behaviours and, at the same time, living with experiences of disqualification, accusation and mutual depreciation. In these cases, children express their discomfort with different symptoms, distress or sometimes even pathologies that ‘force’ parents to ask for a help. It seems that the relationships in general, especially intimate ones, nowadays need new ways of communicating to express one’s own experiences and needs, without calling off the other; they need a dialogue focused on the other and on the quality of the relationships. Even if you experience closeness and intimacy, you often don’t manage to listen to the other completely. Being open and interested in another perspective that includes the thinking of the other, which is different from one’s own, is not easy. Often, there is the feeling that one talks to proof truth without any feeling that this own truth could be true without necessarily being right or wrong, better or worse than the other. The quality of relationship does not imply the absence of conflicts or its early solutions. On the contrary, it implies new ways of facing the conflicts, for example continuing to communicate without the need of immediate sharing. Having a conversation and understanding each other in respect of the differences, is still an open task that involves leaving space for subjectivity in an unprecedented way, where selfaffirmation reaches its fullness within the relationship with the other being different from oneself. Sometimes, all this causes loss and disappointment towards the other, suffering and misunderstanding. Recognising that the thought of the other, even if different from ours, also tells us
15 Cf. V. Conte (2008), Essere coppia nella post-modernità, in A. Ferrara, M. Spagnuolo Lobb (eds.), Le voci della Gestalt. Sviluppi e innovazioni di una psicoterapia, Franco Angeli, Milan, 168173.
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Often, couples ask for help because despite being united by a strong feeling, their daily life becomes unbearable
It seems that the relationships in general, especially intimate ones, nowadays need new ways of communicating to express one’s own experiences and needs, without calling off the other; they need a dialogue focused on the other and on the quality of the relationships
Recognising that the thought of the other, even if different from ours, also tells us something about ourselves, about our fears and difficulties, is important in order to avoid remaining crystallized in the initial way of living the relationship
Feeling that you can’t educate a child alone is the starting point for coparenting
Feminine and masculine represent the two main educational perspectives in the educational visions: being present and becoming. These are two educational pushes that must be co-present in the child’s education
something about ourselves, about our fears and difficulties, is important in order to avoid remaining crystallized in the initial way of living the relationship, to open to new resources and creative energy, to grow in the relationship with the other, making sure that it can turn into fullness for both in the couple. It is impossible that a couple doesn’t go through disappointments and dissatisfaction throughout their relationship, and if the partners don’t find the tools to go beyond the physiological crisis, which allows the couple to evolve from the initial way of being together to a deeper bond, then the couple won’t last. The labile and uncertain boundary between the possibility of fullness or failure of conjugality and parenthood is a great challenge that gives us unprecedented resources of post-modernity. Giovanni Even if, for whatever reason, the other parent is not physically present, the alone-standing parent should ask him/herself: «What would he/she say, what would he/she do?». One can become a ‘parent-with’ only by comparison, by a revision of certainties. Feeling that you can’t educate a child alone is the starting point for co-parenting. It is like going beyond any unique and univocal thought. It is well known that comparison means growth: not only for the child being co-educated, but for every parent. Indeed, parents who enter into real dialogical and relational logic − the meeting in the ‘land of everyone and no one’ – instil models that help the growth and more and more develop their own relational skill with the awareness of being parents (we can talk of ‘evolutional phases of the child-parents bodies’). Feminine and masculine represent the two main educational perspectives in the educational visions: being present and becoming. These are two educational pushes that must be co-present in the child’s education. Each parent takes on one of these perspectives, but opens up to the other in the mindfulness that the perspective of the other co-parent is necessary. It’s a modelling for children (beyond their easy siding with the parent that is more inclined to becoming than to caring) and a richness for society, which needs relational logic.
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Aluette With regards to the couple, you, Valeria, refer to the primary on-between and show us a glimpse of the challenges or different paths that a couple (marital and co-parental) can go, finding a sort of ‘crossroads’ between full experiences and failures. From a clinical point of view, in your experience with couples, is it possible to overcome the sense of emptiness or failure, in order to feel (and perceive) in fullness with the other, starting right from the on-between coordination? Valeria Emptiness and failure after a separation intensify if accusations and mistakes are only projected toward the other; it’s like a sort of dependence and counter-dependence, which is difficult to heal because it remains outside of oneself. One needs to work towards a return to oneself (intrapersonal on-between) through the therapeutic relationship that allows to retrace the interrupted paths, with the primary on-betweens for the creation of an intrapersonal on-between.
Aluette According to the GT vision, it’s possible to fully live one’s one parenthood starting actually from the body. How can the corporeal dimension (and intercorporeity) guide a parental couple in carrying out their caring functions? Giovanni As mentioned, the Personality-function is corporeal. Thoughts related to identity and relations arise from the body, evolve inside the body and express themselves with the body. A body that desires a gesture from a parent, with the gesture not happening (‘missed gesture’), remains pending, assumes antalgic postures that act like a protection. However, in the long term, such creative adaptation produces suffering and becomes a contact interruption. On the other hand, if one has experienced a free and healthy intercorporeal on-between – in which the parent is not afraid of approaching the child and allows him to get closer and permits the spontaneous expression of feelings, emotions and desires, trusting that everything well contextual-
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According to the GT vision, it’s possible to fully live one’s one parenthood starting actually from the body
Thoughts related to identity and relations arise from the body, evolve inside the body and express themselves with the body
Feeling like men and women in the fullness of one’s gender identity, able to ‘think oneself’ with the co-parent and living in a ‘familiar’ dimension, makes each contact flow with harmony and warmth
ised can only benefit the person and relationship as well – one can grow as an authentic person, able to fully live one’s own relational paths. In the background of a healthy and free relationship between parent and child there is, obviously, a likewise quiet relationship between parents or at least − as mentioned – a relationship managed with serenity. Feeling like men and women in the fullness of one’s gender identity, able to ‘think oneself’ with the co-parent and living in a ‘familiar’ dimension, makes each contact flow with harmony and warmth. We also see it in our family therapy sessions, when sitting next to one parent or another produces an inner and corporeal dance that really moves. It seems absurd, but often many tangles can be twisted by the simple fact that one can finally can approach the parent, look in his eyes, feeling one’s own body right in front of the parent’s one16.
Aluette «The bond of each parent with the child is linked and conditioned within a triadic joint. The discomfort of the child is a figure that emerges from the discomfort of his parents» (translated by the author)17. Giovanni, your words highlight the importance of the triadic coordination. In the same way, James McHale18 affirms how important it is to look at the relational field of the father-mother-child triad. Could you describe more in detail how GT looks at the child in a relational sense, rather than intrapsychically, and in a different way from other theoretical or clinical approaches? Giovanni Sure! But let’s take a step back, otherwise we won’t perceive GT’s innovative reach. The triangular family history par excellence in the Western tradition had always been the one of Oedipus and its related vicissitudes. For Sophocles, the tragedies
16 Cf. G. Salonia (2017), Danza delle sedie e danza dei pronomi. La Gestalt Therapy con la famiglia, Il Pozzo di Giacobbe, Trapani. 17 G. Salonia (2013), Edipo dopo Freud. Dalla legge del padre alla legge della relazione, cit., 36. 18 Cf. J.P. McHale (2010), La sfida della cogenitorialità, cit.
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of this triad were caused by Oedipus’ desire of power over his father, whose Gods had stopped by intervening with their revenge. For Freud, the real reason of the family conflict was a sort of power struggle, but rather for the bed than for the throne. As if Oedipus tried to contend his father for the privilege of a priority love with the woman. He was already a step forward, since at least aware of the woman’s existence, as an element present between the two. However, it was still the point of view of an austere and chauvinist Habsburg Vienna. With the beginning of post-modern society (and nowadays horizontal), the focus went more towards the relationship between parents and it was realized that the querelle is not between father and son, but between father and mother. In other words, it’s not Oedipus who incestuously desires his mother against his father, but the conflict between mother and father with the son as a scapegoat. Oedipus (the son) was finally freed from attributions that served, in my opinion, only to justify his parents’ distortions or defaults, and the question got back to the real sphere of where it happens. GT cleans up the parent-saving theories! It reverses the reading paradigm of family relationships. It looks at the at the primary triangle with new eyes. If for Freud ‘the third’ was present, but in the background, as a loot to contend, the ‘third’ element got more attention in other theories. But the point is not just a matter of changing the dyadic perspective for a triadic one. McHale and his collaborators focused on mutual behaviour, describing co-parenting as a sort of coordination between adults. The group of Lausanne observed the interactions by isolating single moments, but always remaining with a privileged focus on what happens at dyadic level (only in a final fourth moment they observe how the child plays with both parents). Stern even cites the grandmother as an element of the triangle... GT, instead, assumes a different and specific hermeneutics: it looks at the experiences and quality of contact between co-parents in the first instance, and, in return, to the one between parents and child. A Gestalt therapist never loses sight of the fact that what happens between two persons is a figure of what happens between three persons. It doesn’t just observe behaviours, but works on corporeal-relational experiences, such as feelings, corporeal tensions, blocked breath, expectations, fears, resistances, and all that.
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It’s not Oedipus who incestuously desires his mother against his father, but the conflict between mother and father with the son as a scapegoat
GT cleans up the parent-saving theories!
A Gestalt therapist never loses sight of the fact that what happens between two persons is a figure of what happens between three persons. It doesn’t just observe behaviours, but works on corporeal-relational experiences, such as feelings, corporeal tensions, blocked breath, expectations, fears, resistances, and all that
Aluette According to the phenomenological perspective of GT, the clinician orients himself toward the feelings experienced at the contact border (a place in which each existential experience happens) and not through the pure observation of behaviours. In line with the GT approach, which variables, not merely descriptive, could orient the researcher during the observation of the triad within the triadic field (such as for the LTPc19)?
Among the experiences that a healthy co-parenting relationship should generate there is, first of all, the respect or, more precisely, the recognition that the other parent is interested and willing – even if in different ways – to the growth and well-being of the children
The interest in a different educational perspective – after the first moment of shock – opens up unthought or underestimated horizons
Giovanni At a descriptive level, we look primarily at the body and all the messages it expresses. From the posture to any muscular contraction, from a more or less alert eye to the furrowed forehead, up to the enlightening expression of the eyes. Moreover, GT specifically observes breathing, as it represents the contact border par excellence between the inside and the outside. We instinctively hold our breath if we feel tension, and we release it if we feel relaxed. We could say that the modulation of breathing indicates exactly how the experience of contact is going. If the breath was a cursor, it could thoroughly trace – similar to a seismograph − the entire course during the encounter. Proxemics is crucial as well: it’s what we define ‘the dance’, as already mentioned. GT is not descriptive but phenomenological, but also looks at what is only indirectly observable: experiences. Among the experiences that a healthy co-parenting relationship should generate there is, first of all, the respect or, more precisely, the recognition that the other parent is interested and willing – even if in different ways – to the growth and well-being of the children. At this point, the interest arises to fully understand the educational thought and the experience of the other parent, without early interruptions or evaluations. The interest in a different educational perspective – after the first moment of shock – opens up unthought or underestimated horizons. If these processes of recognition and interest occur, a kind of gratitude spontaneously pours out for having received a perspective that widens the horizon, even if it could create perplexity. When the co-parental
19 Cf. E. Fivaz-Depeursinge, A. Corboz-Warnery (2000), Il triangolo primario, cit.
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couple manages to bring out reciprocal gratitude inside and through the different educational perspectives, openness, energy and relational dance circulate within the family triangle.
Aluette Citing your thought, Giovanni: «The primary on-between is in fact the first form of inter-personal in-between between the child and the significant figures, through which an access to the intra-personal on-between is possible. This is the first task of every growth. For this to happen, the presence of an adult who takes care of and helps the child to get to himself is needed. The Ego arrives to itself only if a You helps with it»20 (translated by the author). Could you give us a clinical example? Giovanni The primary ‘on-beetween’ – which I have elaborated in dialogue with Kimura – happens every time someone takes care of and helps the child (the other) in order to get to him/herself. It’s a physiological development stage or a healing path that cures the suffering of those who, according to Kierkegaard, are no longer able ‘to be on first name with oneself’21. I always remember with deep feeling a situation, where two parents came to us with a little, very active girl they had adopted. The girl wouldn’t stay still for a moment, going up and down the chair; the couple tried to hold her back or have her sit on their lap, but she would free herself very easily. The mother was a big woman, a bit static and rigid in her movements. I suggested her to take the little girl in her arm and tell her something, while I asked her husband to stay behind her. The little girl let herself rest on her mother’s knees, so she could begin to tell her about when they had adopted her: «We came to the institute, we saw you... your hair was... I held you in my arms...». The more she talked, the more her body relaxed, while the girl was listening and her body relaxed as well. The father was a bit bent over them, as if
20 G. Salonia (2013), L’esser-ci-tra. Aida e confine di contatto in Bin Kimura e in Gestalt Therapy, cit., 14. 21 Cf. S. Kierkegaard (1980), Diario, Morcelliana, Brescia.
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The primary ‘onbeetween’ – which I have elaborated in dialogue with Kimura – happens every time someone takes care of and helps the child (the other) in order to get to him/ herself
My body felt the tenderness of a joke that put together, gratitude, warmth and embarrassment
he would collect their bodies in a single hug. Our bodies were listening too. Silence... Valeria, who was pregnant at the time, was particularly moved... Do you remember? It was touching. When we said goodbye at the end, the little girl – so cute! – turned to me with her face taking on a worried expression, and told me off: «You rascal!». My body felt the tenderness of a joke that put together, gratitude, warmth and embarrassment.
Aluette Valeria, your experience allows you to affirm that the background of stable primary relationships disappeared in patients with severe emotional distress, in other words, the ground of a secure base, so that it was not possible for them to experiment and assimilate different experiences. When this happens, do you share a therapeutic path with background related to the recovery of a new learning of ‘being-in-between’ patterns of the primary on-between (‘the relational house the patient lived in’)? Valeria Working with serious patients certainly concerns the construction of the place and caring relationships. The assumed background, ground of secure base, is built within steady primary relationships, where one can experiment and assimilate different experiences. If this is missing and the primary on-betweens do not offer such security, in different ways, the experience needs to be continuously updated/verified, as if the ground was cut from under one’s feet22. As Giovanna Giordano reminds us, «those who lack of experience of warmth and intimacy experienced primarily at home, suffer from a serious denial of the possibility and the sense of their existence in the world, which will be experienced in an alienated and alienating manner» (translated by the author)23.
22 Cf. V. Conte (2011), Gestalt Therapy and serious patients, in «GTK Journal of Psychotherapy», 2, 17-48. 23 G. Giordano (2001), La casa, l’ambiente non umano e i pazienti gravi. Un contributo teorico-clinico nell’ottica della psicoterapia della Gestalt, in «Quaderni di Gestalt», XVII, 32/33, 70-79, 71.
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Aluette So, what does the ‘heart of co-parenting’ mean? In other words, to be co-parents, does one necessarily need to share a unique thought that reduces the differences of the two partners (of thought, of educational style, etc.)? Giovanni The reflections on co-parenting often recall the famous episode of the child disputed by two mothers. Solomon’s solution of cutting the child in two parts triggered the scream, the mother’s vibration in the flesh of the true mother: «No, give him to her, but don’t kill him». The help to co-parenting – especially in the most dramatic situations, such as separations by non-mutual consent – has one aim: the parent’s bodies shall feel that powerful co-parenting vibration, which leads to openness to take a step back towards a co-parenting encounter, which protects the child from suffering. Perhaps, then, the heart of co-parenting consists of giving human beings a new mindfulness: not only parents educate their children, but also children cause and require their parents’ growth. Children avoid that conflictual parents destroy each other by leading them with their little hand, their smiles, their tenderness and their vulnerability in that locus amoenus, where everyone learns compassion for their own and others’ pain, for their own and others’ frailty.
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Perhaps, then, the heart of coparenting consists of giving human beings a new mindfulness: not only parents educate their children, but also children cause and require their parents’ growth
Abstract The interview starts with an introduction to co-parenting as evolutional challenge, a possible growth children offer to their co-parents. The topic of co-parenting as anthropological, clinical and epistemological turning point connected to the social changes of post-modernity. In particular, crucial topics that concern the family and co-parenting in the current social context are discussed. Furthermore, the interview deals with the topic of homosexual (co)parenting, the possibility of being parents even without being married or with the relationship being highly conflicting. In closing, the editor links to Giovanni Salonia’s and Valeria Conte’s clinical and research work, in order to give the meaning of co-parenting a frame by connecting it with the theory of the familiar Self, the evolutional theory, the work on a body and the theory of dual thought.
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The sound of thought
Ambition
NEW CLINICAL PATHWAYS
THE VIOLINIST’S CRAMP GESTALT THERAPY IN THE TREATMENT OF FOCAL HAND DYSTONIA OF A MUSICIAN’S HAND by Giovanni Turra and Elena Ponzio
Dystonia can be caused by many factors, especially in presence of some predisposing factors, such as psychological, psychosocial and physiological stress
Focal Hand Dystonia (FHD) is described as a movement disorder characterized by involuntary and sudden contractions of hand muscles. It can affect professional groups but is more common among musicians. Hence the name “musician’s cramp”. Studies and results of the EMG’s showed that this dysfunction involves co-contractions of agonist and antagonist muscle groups as well as hyperactivity of inappropriate muscles1. Around 1% of professional musicians are affected by focal hand dystonia and, in most of the cases, the movement disorders that arise from it lead to the end of their career. The aetiology of this disease is still unknown and inaccurate. Dystonia can be caused by many factors, especially in presence of some predisposing factors, such as psychological, psychosocial and physiological stress. There is no certainty about the effectiveness of therapies and, what’s more, there is no concordance between cures and rehabilitation therapies for the affected patients. Moreover, the aspect of psychological and social distress of musicians affected by such dysfunction has to be evaluated as well, as it limits the sense of expressive and professional fullness. Therefore, besides examinations and neurological, orthopaedic and physiotherapeutic interventions, the idea was to offer psychotherapeutic support according to the theoretical-clinical model of Gestalt Therapy (GT). With its phenomenological approach, the theory of contact cycle and integration of the Id functions, intercorporeity, the research of missed and expected gestures, the antalgic posture and the complementary body (and also the case on anxiety), GT is considered to be an appropriate model to offer psychotherapeutic support to musicians affected by FHD attending rehabilitation. This is possible if the patient is seen in the entirety of his/her needs, starting from the first want 1 Cf. L.G. Cohen, M. Hallett (1988), Hand cramps: clinical features and electromyographic patterns in a focal dystonia, in «Neurology», 38, 1005-1012.
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to live his/her condition through the senses, to explore his/her experiences before and after the disease’s onset, and overcoming the mind-body dichotomy by leading him/her through the attempts made to change his/her own condition, i.e. the recovery of the “musical gesture” affected by FHD.
Freedom of the musical gesture as psycho-physical and existential topic As for the freedom of the musical gesture, several aspects need to be taken into account: the correspondence of the gesture with the personal sensitivity (formed in early relationships) with the posture (also ‘history’ of relationships) and with the environment. Hence, the genesis is in the “contact” between Organism (hereinafter referred to as O.) and Environment (hereinafter E.). The spontaneous gesture first of all represents the musician’s self-in-contact, and secondly the lack of effort (fluidity) and anxiety that prevent the normal movement flow. The musician can run into two problems: on one hand, technical rigidity where one tends to detach the instrumental performance from a purely corporeal feeling; on the other hand, the excessive involvement, where the sense of feeling turns into overabundant levels of anxiety, which at the same time risks to block the music flow. Even the excessive tendency to control is none other than anxiety interfering and blocking the freedom and spontaneity of the gesture. The musician is often obsessed by trying to control those corporeal processes: if left with their naturalness, they would “play well” by themselves. The importance of the gesture can be placed here: the confidence in the spontaneity of the musical gesture and in the processes one’s own body carries out. This is why patients need a perceptive and affective-relational method concerning stability and corporeal flexibility, the Basic Relational Model and their relational story, also in relation to musical activity2. The higher the capacity of the person is to trust him/herself and confide in the E.
2 Cf. G. Salonia, V. Conte, P. Argentino (2013), Devo sapere subito se sono vivo, Il Pozzo di Giacobbe, Trapani.
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The spontaneous gesture first of all represents the musician’s self-in-contact, and secondly the lack of effort (fluidity) and anxiety that prevent the normal movement flow
The importance of the gesture can be placed here: the confidence in the spontaneity of the musical gesture and in the processes one’s own body carries out
The higher the capacity of the person is to trust him/ herself and confide in the E. and in the music instrument, the better will be his/her ability to create spontaneous and fluid musical gestures. Thus, music becomes a gesture and the sound is again the body, a ‘circuit’ that creates the possibility of artistic expression
and in the music instrument, the better will be his/her ability to create spontaneous and fluid musical gestures. Thus, music becomes a gesture and the sound is again the body, a ‘circuit’ that creates the possibility of artistic expression. In this sense, art is understood both as stability and flexibility of a ‘relational gesture’ translating the musical thoughts encoded by the score into sounds, and conversely, as translation of the sound in ‘becoming a corporeal relationship’. Hence, the musician uses the music instrument as translation ‘instrument’ of his/her own corporeity in sound-space.
Music Performance Anxiety (MPA) with relation to Anxiety in GT Albeit FHD is a neurological movement disorder causing no pain, Marsden and Sheehy3 gave proof of the possible psychological component as one of the triggering factors. Following researches indicate that musicians affected by FHD show that they excessively invest in the conscious evaluation of mistakes, which could be related to an excessive and constant self-evaluation of behavioural adaptation and of movement during the performance of music4. This leads us to consider the theory of psychotherapeutic treatment as coadjutant in the treatment of FHD. The particular form of Anxiety you find most in musicians is the one that different authors define as Music Performance Anxiety (MPA). Kenny recently suggested a definition of MPA that is in agreement with the research regarding anxiety disorders and social phobia: «Music performance anxiety is the experience of marked and persistent anxious apprehension related to musical performance that has arisen through specific anxiety conditioning experiences and which is manifested through combinations of affective, cognitive, somatic and be-
3 Cf. C.D. Marsden, M.P. Sheehy (1982), Writers’ cramp-a focal dystonia, in «Brain», 105, 461-480. 4 Cf. E. Altenmuller, H.C. Jabusch (2010), Focal dystonia in musicians: phenomenology, pathophysiology and triggering factors and treatment, in «Medical Problems of Performing Artists», 25, 1, 3-9.
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havioural symptoms. It may occur in a range of performance settings but is usually more severe in settings involving high ego investment and evaluative threat. It may occur comorbidly with other anxiety disorders, in particular social phobia5. Many musicians suffer from MPA. Having said this, we believe that using GT’s theory and praxis in the treatment of FHD and MPA (which are often combined in a musician) is an epistemologically valid choice. In GT, anxiety appears in the body as an interruption of corporeal-relational experiences of a contact episode, pointing out the interruption of its sequence and of the growth of the O. Interrupting a road that was already taken, and the excitement resulting from it, turns into a source of anxiety and prevents the O. to complete one’s wilfulness, and to grow. Experiences in GT have three features: they are corporeal (marked and visible on the body), relational (directed towards the other) and temporal (present in the evolutional here-and-now, as it is part of a before or an after that marks the contact event). The O. starts to identify the need, and notices an increasing excitement and energy that are needed to move towards the E. The extent of breath widens, the energy expands and the body is perceived as mainly activated. However, on the other hand, so much available energy intensifies fear of not being aware of the result. This is how movements towards the contact limit start. If the O. is supported, it relies on its own energy and carries on, while without the specific support at this stage, the O. perceives its corporeal scheme as restricted, with its limits being closer rather than in expansion towards the E. At this point, excitement is felt like being unbearable and the O. doesn’t recognize it as its own anymore, and rather attributes it to the E. The actions resulting from it are not quite directed towards the contact, since they are aimed to let off steam and not to reach a target6.
5 D.T. Kenny (2009), Negative emotions in music making: performance anxiety, in P. Juslin, J. Sloboda (ed.), Handbook of music and emotions: theory, research, application, Oxford University Press, Oxford, 425-451, 433. 6 Cf. G. Salonia, (2013), L’anxiety come interruzione nella Gestalt Therapy, in G. Salonia, V. Conte, P. Argentino, Devo sapere subi-
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We believe that using GT’s theory and praxis in the treatment of FHD and MPA (which are often combined in a musician) is an epistemologically valid choice
The extent of breath widens, the energy expands and the body is perceived as mainly activated. However, on the other hand, so much available energy intensifies fear of not being aware of the result
We interpret the dystonic gesture as an “antalgic posture” following an absence of support in case of excitement, and the anxious state of the dystonic musician as an interruption of the contact
The patient is necessarily lead through getting an awareness of his/ her own body, feelings, perceptions and tone variations, in order to become aware of the ‘non-felt’ corporeal regions and learn to perceive the manifestation of FHD
Hence, we interpret the dystonic gesture as an “antalgic posture” following an absence of support in case of excitement, and the anxious state of the dystonic musician as an interruption of the contact. A further basic element in the treatment of the Anxiety in GT is the triadic dimension of the founding relationship and of psychotherapy7, where the therapeutic ‘couple’ is not the therapist-patient one, but rather the triad therapistco-therapist-patient, similar to the parent-child relationship, in which one actually has to consider the father-mother-child relationship. The co-therapist can be internal. However, in the treatment of musicians affected by FHD that also suffer from MPA, the ‘therapeutic couple’ consists of professionals featuring different characteristics: psychotherapist, orthopaedist, neurologist, physiotherapist, etc. Therefore, the offered support has to be multi-professional, integrating the intervention on motor dysfunction with the emotional and corporeal-gestural experiences. For example, the physiotherapist won’t consider only the physical and cognitive aspects, but also the emotional and relational ones. The same applies to the Gestalt psychotherapist: he or she won’t just consider the emotional-relational tones, but will work together with the physiotherapist, taking into account tension, breath, corporeal contractions and their rhythm, and gestures.
Phenomenological analysis: FHD as antalgic posture and missed/expected gesture The patient is necessarily lead through getting an awareness of his/her own body, feelings, perceptions and tone variations, in order to become aware of the ‘non-felt’ corporeal regions and learn to perceive the manifestation of FHD, which, as already mentioned, doesn’t include physical pain. The musician’s body goes through a lot of pressure on its long education path, in order that his/her posture with the instrument is the one the teacher considers most suitable for the music performance.
to se sono vivo, Il Pozzo di Giacobbe, Trapani, 33-53. 7 Cf. ibid., 50.
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During the long training, teachers mainly make notes and turn their attention directly to the pupil’s body. In the onset of FHD, together with the quality of the teacher-pupil relationship, this plays an important role. And this is the reason why the established relationship between patient and therapist becomes crucial during rehabilitation: if it features the same elements of the relationship in which FHD rose, the functional recovery will turn out problematic. Considering FHD as an antalgic posture, we compare the muscular-emotional block to a ‘missed gesture’. We see a non-accomplishment of a precise gesture in a precise relationship. It is about the interruption of a relationship with somebody and the place of psychic distress. With the intervention, psychotherapist and patient cooperate to trace the missed ‘corporeal-relational gesture’8. So, picking up the object-violin is an identity-making gesture that gives access to an expressive experience of the Self in contact with the E. As antalgic posture and muscular-emotional block, FHD tells us about the interruption of a precise gesture in a precise relationship. In accordance with this, we focused on the corporeal-relational block in the here-and-now with the therapist, through which we could trace the missed and/or expected corporeal-relational gestures. The test, the perception of one’s own body and experiences, is illuminating. The trust in corporeal feelings based on the phenomenological prospective – according to which the body is the immediate object of awareness and becomes the intermediary between itself and the world – is one of the preliminary conditions to favour and reinstate throughout the entire therapeutic experience with an FHD affected musician9. The context in which the body mainly identifies itself as main figure of the scene is the pain/distress experience that generally persistently draws attention to itself, confining world issues to an indistinct background. Therefore, it is important to consider the research of the musician’s sensitive body as a privileged
8 Cf. G. Salonia (2008), La Gestalt Therapy e il lavoro sul corpo. Per una rilettura del fitness, in S. Vero, Il corpo disabitato. Semiologia, fenomenologia e psicopatologia del fitness, Franco Angeli, Milan, 51-71, 62-63. 9 Cf. M. Merleau-Ponty (1965), Fenomenologia della percezione, Il Saggiatore, Milan, 457.
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Considering FHD as an antalgic posture, we compare the muscularemotional block to a ‘missed gesture’
As antalgic posture and muscularemotional block, FHD tells us about the interruption of a precise gesture in a precise relationship
One musician said to us: «I am terrified by the fact that if I really let go my voice, what else could come out with you?»
When the patient recovers his/ her own missed gesture within the relationship with the therapist, he/ she experiences the integrity of the body and the fullness of feeling it in all its parts
path to comprehend symptoms and suffering in general, and to set up a therapeutic path that suits the patient. The relational and dialogical approach provides a supporting ground where the performer is encouraged to explore and evaluate his/ her subjective experience. One of the reasons why musicians can benefit from GT approach is that both body and breath (diaphragm) are involved when they play an instrument. Diaphragm, throat, shoulders, arms: body parts that often reveal retroflexed feelings and experiences. One musician said to us: «I am terrified by the fact that if I really let go my voice, what else could come out with you?». GT’s contact cycle is particularly effective when working with performers, as their stages of sensation, awareness, directionality, excitement and action are unveiled in the contact with instrumental practice. The ground of MPA problems, vocal and/or articular difficulties, etc., are often already clear from the way of learning how to play. One of the most common interruptions of contact cycle is what the performers do with sensations and the corporeal awareness: they are sometimes disconnected from their body and are desensitized while playing. In GT, the central position of body and action (seen as autonomous experience that verifies and modifies the thought that precedes it, by generating new ones) is the place where decisive elements of one’s own identity are tested and learnt. This is a very distinctive characteristic of the experience of a dystonic musician. The technique, of which GT is proud of, to ask and repeat and amplify a gesture, in order to become aware of the experience this gesture expresses (‘missed gesture’) gives the therapist the opportunity to offer specific support, so that the patient will be able to go through the related stress and fulfil ‘that’ gesture, which defines the relationship with the therapist in a new way. The ‘missed gesture’ is therefore a precise, unique and irreplaceable gesture. When the patient recovers his/her own missed gesture within the relationship with the therapist, he/she experiences the integrity of the body and the fullness of feeling it in all its parts. The ‘missed gestures’ include the relational story of a person and each body highlights the signs of non-accomplished gestures and, therefore, of traumatic interruptions that prevent the experience to be assimilated. The ‘missed gesture’, which genesis is a past relationship, pushes to be accomplished and emerges in the
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here-and-now of the therapeutic relationship, presenting itself in an original and creative way within the current situation10. Hence, the missed gesture remains in the patient’s corporeal memory and energises itself through the excitement that blocked its path through the full contact, and turns into anxiety each time the desire reappears. The aroused gestures in anxiety are informed by the distress because they ‘take the place of’ other gestures. So, the dystonic symptom is also an appeal at the end of a contact event: a ‘missed and/or expected gesture’ (and never received) that expresses the corporeal-relational experiences11. We explored the relational history (not only with the family, but also with music and the instrument, the teachers, mates/colleagues, institutions) together with the patients, defined their missed/expected gestures – and we did it in presence of their instrument. The experience of the ‘expected gesture’ was very important. In those patients, we were faced with bodies that expected a gesture, and when they did not receive it, it ensured that their breath would be hold, focused and alerted while waiting for that gesture in that relationship. Such experience, when repeated, made sure that the patient would feel his/her body contracted and breath held each time he/ she approached similar situations, without remembering the primal events. Such situation prevents to fully experience the new contact events offered by new relationships12 and new musical relationships. GT considers the breathing block in anxiety as an ‘increasing breathing block’ rather than a simple breathing block. The same is valid for every other movement and gesture, including the musical one. Dystonic posture (namely the entire body of FHD affected musicians) is a posture that is adopted to avoid feeling pain. A posture of a body that blocks and stops breathing; of a body that is taken into the world as ‘complementary body’ of another body, which caused the posture and which continues to influence it in the present, even if not useful anymore. Hence, the dystonic gesture is a gesture
10 Cf. G. Salonia (2008), La Gestalt Therapy e il lavoro sul corpo, cit. 11 Cf. G. Salonia, (2013), L’anxiety come interruzione nella Gestalt Therapy, cit. 12 Cf. ibid.
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The missed gesture remains in the patient’s corporeal memory and energises itself through the excitement that blocked its path through the full contact, and turns into anxiety each time the desire reappears
The dystonic gesture is a gesture that forbids the ‘other’ body to fully express itself or that didn’t get the needed support
that forbids the ‘other’ body to fully express itself or that didn’t get the needed support. The therapeutic work wanted to release patients with FHD from carrying bodies that prevented a full musical gesture. Indeed, the missed gesture, which became antalgic posture, includes the same contact and relational wilfulness of the patient and, therefore, his/her directionality and existential musical next.
The co-therapy method
We see the dystonic gesture as an antalgic posture, a suddenly and traumatically interrupted contact; an ‘interrupted gesture’ that asks to reveal the ‘missed and/or expected gesture’ in order to be able to continue growing
By working with FHD affected musicians, the intervention was also based on the following parameters: Globality: the gloablity of the person-musician with focal dystonia has to be considered, and not only the local part representing the motor dysfunction. Placed condition: it is necessary to open ourselves up to observe and be there with the person and his/her problem in the revealed situation. The real scene has to be understood and tested in the therapeutic experience. During psychotherapy session, it was important to place the contact. Psychotherapy and physiotherapy sessions were carried out with the patient and the instrument, while considering the scene, in which the problem arises. First person experience: the personal somatosensory experience and the related emotional and relational experiences are considered. Contact and its interruption: as already highlighted, we see the dystonic gesture as an antalgic posture, a suddenly and traumatically interrupted contact; an ‘interrupted gesture’ that asks to reveal the ‘missed and/or expected gesture’ in order to be able to continue growing. Psychotherapeutic intervention with patients often occurred at the same time (sometimes in conjunction, sometimes separately, based on the need) as physiotherapy, either phenomenological or cognitive13. Something is learnt in the recovery process,
13 Cf. N. Migliorino (2010), Il gesto terapeutico. Forma e contatto, Franco Angeli, Milan.
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since the processes (neuropsychological and neurobiological) that are at the base of the learning process are also at the base of recovery14. The purpose of motor re-education was the recovery of related specific motors of each of the altered functions (in musicians with FHD, the body that is free from excess of tensions allows the hand to be a receptive organ, which is able to globally adapt itself to the contact with the music instrument). Based on this, we can round off that GT has positively integrated and supported physiotherapy interventions. At the end of the therapy, a patient told us: «In early times, the first object my fury was directed to, in order to go beyond my limit, was myself. And the doll broke, as you know. But I didn’t throw it away. On the contrary, I take care of it without a break, with affection and apprehension, constantly hanging in the balance between the dream to see it recovered and the more concrete compromise to be able to fix it».
14 Cf. C. Perfetti (1997), La riabilitazione motoria dell’emiplegico, Ghedini, Milan.
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«In early times, the first object my fury was directed to, in order to go beyond my limit, was myself. And the doll broke, as you know. But I didn’t throw it away. On the contrary, I take care of it without a break, with affection and apprehension, constantly hanging in the balance between the dream to see it recovered and the more concrete compromise to be able to fix it»
REFERENCES
Altenmuller E., Jabusch H.C. (2010), Focal Dystonia in Musicians: Phenomenology, Pathophysiology, Triggering Factors and Treatment, in «Medical Problems of Performing Artists», 25, 1, 3-9. Bhatia K.P., Marsden C.D. (1994), The behavioral and motor consequences of focal lesions of the basal ganglia in man, in «Brain», 117, 859-876. Brotons M. (1994), Effect of performing conditions on music performance anxiety and performing quality, in «Journal of Music Therapy», 31, 1, 63-81. Clark D.B., Agras W.S. (1991), The assessment and treatment of performance anxiety in musicians, in «American Journal of Psychiatry», 148, 5, 598-605. Cohen L.G., Hallett M. (1988), Hand cramps: clinical features and electromyographic patterns in a focal dystonia, in «Neurology», 38, 1005-1012. Conte V. (2013), La modalità relazionale narcisistica nella postmodernità e il lavoro terapeutico in gestalt therapy, in «GTK Rivista di psicoterapia», 4, 17-34. De Monticelli R. (1998), La conoscenza personale. Introduzione alla fenomenologia, Guerini e Associati, Milano. De Monticelli R. (2003), L’ordine del cuore. Etica e teoria del sentire, Garzanti, Milan. Downing G. (1995), Il corpo e la parola, Astrolabio, Rome. Evans A., Evans A. (2013), Secrets of performing confidence, Bloomsbury, London. Gadamer H.G. (1983), Verità e metodo, Bompiani, Milan. Gallagher S., Zahavi D. (2009), La mente fenomenologica, Raffaello Cortina, Milan. Jabusch H.C., Altenmüller E. (2004), Anxiety as an Aggravating Factor During Onset of Focal Dystonia in Musicians in «Medical Problems of Performing Artists», 19, 2, 75-81. Jankovic J. (1995), Tardive syndromes and other drug induced movement disorders, in «Clinical Neuropharmacology», 18, 197-214. Kenny D.T. (2009), Negative emotions in music making: performance anxiety, in Juslin P., Sloboda J. (ed.), Handbook of music and emotions: theory, research, application, Oxford University Press, Oxford, 425-451. Kenny D.T. (2011), The psychology of music performance anxiety, Oxford University Press, Oxford. Kesselring J. (2006), Music performance anxiety, in Altenmuller E., Wiesedanger M., J. Kesselring J. (ed.), Music, motor control and the brain, Oxford University Press, Oxford, 309-318.
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Lederman R.J. (1999), Medical treatment of performance anxiety: a statement in favor, in «Medical problem of performing artists», 14, 3, 117-121. Marsden C.D., Sheehy M.P. (1982), Writers’ cramp-a focal dystonia, in «Brain», 105, 461480. Merleau-Ponty M. (1965), Fenomenologia della percezione, Il Saggiatore, Milan. Migliorino N. (2010), Il gesto terapeutico. Forma e contatto, Franco Angeli, Milan. Moraru E. et alii (2002), Relation between depression and anxiety in dystonic patients: implications for clinical management, in «Depression and Anxiety», 16, 100-103. Noë A. (2010), Perché non siamo il nostro cervello, Raffaello Cortina, Milan. Nygaard T.G. et alii (1993), Linkage mapping of Dopa-responsive dystonia (DRD) to chromosome 14q in «Nature Genetics», 5, 386-391. Osborne M.S., Franklin J. (2002), Cognitive processes in music performance anxiety, in «Australian Journal of Psychology», 54, 2, 86-93. Osborne M.S., Kenny D.T. (2008), The role of sensitizing experiences in music performance anxiety in adolescent musicians, in «Psychology of Music», 36, 4, 447-462. Perfetti C. (1997), La riabilitazione motoria dell’emiplegico, Ghedini, Milan. Perls F., Hefferline R., Goodman P. (1997) (ed. or. 1951), Teoria e pratica della Terapia della Gestalt, Astrolabio, Rome. Powell D.H. (2004), Treating individuals with debilitating performance anxiety: an introduction, in «Journal of Clinical Psychology», 60, 8, 801-808. Reciniello R. (1991), Towards an understanding of the performing artists, in Wilson G.D. (ed.), Psychology and performing artists, Sweets and Zeitlinger, London. Rossi F. (2010), Figure del male e della sofferenza nella filosofia francese del Novecento, Franco Angeli, Milan. Salmon P. (1990), A psychological perspective on musical performance anxiety: a review of the literature, in «Medical Problems of performing artists», 5, 1, 2-11. Salonia G. (1989), Dal noi all’io-tu: contributo per una teoria evolutiva del contatto, in «Quaderni di Gestalt», 8/9, 45-53. Salonia G. (1989), Tempi e modi di contatto, in «Quaderni di Gestalt», 8/9, 55-64. Salonia G. (2008), La Gestalt Therapy e il lavoro sul corpo. Per una rilettura del fitness, in Vero S., Il corpo disabitato. Semiologia, fenomenologia e psicopatologia del fitness, Franco Angeli, Milan, 51-71.
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Salonia G. (2011), Sulla felicità e dintorni. Tra corpo, parola e tempo, Il Pozzo di Giacobbe, Trapani. Salonia G. (2012), La grazia dell’audacia. Per una lettura gestaltica dell’Antigone, Il Pozzo di Giacobbe, Trapani. Salonia G., Conte V., Argentino P. (2013), Devo sapere subito se sono vivo, Il Pozzo di Giacobbe, Trapani. Salonia G., Sichera A. (2013), Edipo dopo Freud, GTK books/01, Ragusa. Spagnuolo Lobb M. (1990), Il sostegno specifico nelle interruzioni di contatto, in «Quaderni di Gestalt», 10/11, 13-23. Stephenson H., Quarrier N.F. (2005), Anxiety sensitivity and performance anxiety in college music students, in «Medical Problems of Performing Artists», 20, 3, 119-125. Thurber M.R. (2007), Effects of heart-rate variability biofeedback training and emotional regulation on music performance anxiety in university students, in «Dissertation Abstracts International», 68 (3-A), 889. Wingfield E. (1999), Performance anxiety in classical singers and musicians. A Gestalt perspective, in «British Gestalt Journal», 8, 2, 96-105.
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Abstract The abstract wants to offer a summarised introduction of theoretic and clinical prerequisites of therapeutic work with musicians suffering from Focal Hand Dystonia. Given that the causes for this dysfunction and the nearly entire neurologic nature of currently suggested therapies are still uncertain (none of them determined yet), the target was to intervene in a holistic and multidisciplinary way with regards to treatment, while also considering the experiences of guilt and the ‘inability’ of musicians affected by FHD to recover. Gestalt Therapy was integrated among the usual medical and physiotherapeutic treatments, trying to consider FHD, in relational terms, as a contact interruption, am ‘interrupted musical gesture’ in a particular relationship.
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Breakfast on the grass
The impostor
SOCIETY AND PSYCHOTHERAPY
FROM ROOTS TO LEAVES VITALITY AND DEVELOPMENT OF GESTALT PSYCHOTHERAPY by Serena Bimbati1 As high a tree might grow, its falling leaves always go back to its roots Chinese proverb 1
Introduction
In the book life is the main subject, starting from the life of those who theorized it. There is a sort of game of mirrors which strikes the reader or the one, like me, who tries to re-weave the tapestries of such a fascinating, mysterious experience which brought a group of seven people to a radical change in the way of interacting and living relationships
The book Gestalt Therapy: Excitement and Growth in the Human Personality was published in 1951 and showed the world a new perspective in psychotherapy which, even if moving from away from psychoanalysis, at the same time accepted its limitations and transformed them into therapeutic and social development opportunities. Starting from Fritz and Laura Perls’s considerations about introjection, the removal of dental aggressiveness, the exaltation of the experience which «occurs at the boundary between the organism and its environment»2 as Goodman said, till the practical transposition of Hefferline, Gestalt therapy offered the human being a new way to live, grow and die better. In the book life is the main subject, starting from the life of those who theorized it. There is a sort of game of mirrors which strikes the reader or the one, like me, who tries to re-weave the tapestries of such a fascinating, mysterious experience which brought a group of seven people to a radical change in the way of interacting and living relationships.
1 Translated by Claudio Balasso. I am very grateful to his accuracy, curiosity and care shown for my article. If not indicated otherwise, quotes not in the original language are always translated by the Author. 2 F. Perls, R. Hefferline, P. Goodman (1994) (or. ed. 1951), Gestalt Therapy: Excitement and Growth in the Human Personality, The Gestalt Journal Press, New York, 3.
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The so-called ‘group of seven’ was formed by Fritz and Laura Perls, Paul Goodman, Elliott Shapiro, Isadore From, Paul Weisz and Sylvester ‘Buck’ Eastman, who together created Gestalt Therapy between the end of the 1940s and the beginning of the 1950s; in the draft of the book Ralph Hefferline joined Fritz Pearls and Goodman later and gave his contribution of practical exercises. The group of seven built own ground for two years every Wednesday in the Perls’s apartment at 315, Central Park West in the West Side of Manhattan to discuss, even energically, about psychotherapy and human growth processes. In the following years there was an increasing number of initiatives and contacts with the outside world, vital outputs in the post-WWII States, which were so busy working towards a social rebirth in the name of modernity and efficiency; in 1951 Gestalt Therapy: Excitement and Growth in the Human Personality was published; in 1952 the New York Gestalt Institute was founded and Laura Perls ran it; in 1954 Cleveland Institute was open and then managed by Paul Goodman and Paul Weisz. In the introduction to the book there is a clear statement of how the book was built, through a mix of common intents and diverging points of view: We have had in common one purpose: to develop a theory and method that would extend the limits and applicability of psychotherapy. Our differences were many, but by bringing them forth rather than politely concealing them we many times arrived at solutions that none of us could have anticipated3. The fact that seven people of different age, personal and professional experience, migrating history and identity, could co-create such a harmonious theory, is a stimulating example of how aggressiveness is «survival, physical and existential growth in any organism: the natural actualization of self-realization pushes»3.
3 M. Spagnuolo-Lobb, G. Salonia (1995), Introduzione all’edizione italiana, in F. Perls (ed.), L’Io, la fame, l’aggressività, Franco Angeli, Milan, 7-10, 9.
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The fact that seven people of different age, personal and professional experience, migrating history and identity, could co-create such a harmonious theory, is a stimulating example of how aggressiveness is «survival, physical and existential growth in any organism: the natural actualization of selfrealization pushes»
Moreover, each of them had directly or indirectly experienced migration, which means a «position in the between» which can become, if consciously lived as it happened to them, an additional resource since it requires moving between alternatives and, subsequently, electing among groups to belong to
Moreover, each of them had directly or indirectly experienced migration, which means a «position in the between»4 which can become, if consciously lived as it happened to them, an additional resource since it requires moving between alternatives and, subsequently, electing among groups to belong to. This constant mediation between the strange and the familiar might have contributed to such encounters between diversity. As Naranjo said in 19915, Gestalt psychotherapy was not founded by only one but a group of thinkers with various cultural backgrounds which created a «whole different from the sum of its single parts. Let’s examine, then, the biographies of these seven parts and note how each of them contributed to the formation of the whole.
The seven roots Friedrich Salomon Perls He was born in Berlin in 1893 and died in Chicago in 1970. He spent a life moving from Europe to the States, from South Africa to the Far East, and experiencing a roller coaster of relationships and contacts. Friedrich Perls was of Jewish descent. His mother, a Jewish churchgoer, died with other relatives in a Nazi concentration camp; his father was a wine dealer, a very violent and unfaithful husband, who bullied and treated him as «a sack of shit»6. Both, though, «were very friendly in public. Confusing»7. In 1916, during the First World War, Friedrich joined the German army and spent time in the trenches as a Red Cross medi-
4 M. Andolfi (ed.) (2003), La mediazione culturale. Tra l’estraneo ed il familiare, Franco Angeli, Milan, 10. 5 www.claudionaranjo.net. 6 S. Ginger (2005), Iniziazione alla Gestalt. L’arte del con-tatto, Mediterranee, Rome, 42. 7 www.gestalttheory.com/fritzperls/autobiography/: «my mother was loving and ambitious. My father loved the arts, but hated most other things. He hated my mother – though he loved other women…both of them were very friendly in public. Confusing».
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cal officer. He became ‘desensitized’, as he says in his own autobiography by the horrors he saw and personally experienced. He got injured on the front and sent back home with clear signs of depersonalization. So he started to study psychiatry and to get interested in Reich’s and Freud’s works. In 1921 he graduated in Medicine in Berlin. In 1923 he went to New York, hoping to obtain the US equivalent to his German degree, but he had to face language difficulty and the highly competitiveness of the American metropolis, thus accelerating his return to Berlin. In 1926 he decided to go into personal therapy with Karen Horney to analyse his sexual perversions he had been having, maybe to energize the depression he had been affected with after his coming back from war. In 1927 he graduated in Neuropsychiatry as an assistant to Kurt Goldstein and decided to move to Frankfurt, at that time the main European intellectual center. Here he met his future wife, Laura, who married in 1930. In the same year he started his fourth didactic analysis with Reich. In 1934, following the advice of Ernest Jones, one of Freud’s friends and his biographer, in order to escape from Nazi persecutions, Friedrich and Laura Perls decided to leave Europe for South Africa. There Friedrich Perls met J.C. Smuts (who had been Prime Minister from 1920 till 1924), whose book Holism and Evolution (published in South Africa in 1926) will be frequently evoked in all Perls’ works. In 1935 Friedrich Perls founded the South African Institution of Psychoanalysis and in 1942 published his first book Ego, Hunger and Aggression, dedicated to his wife Laura for her contribution to the writing of two chapters of the book. From 1942 till 1946 he served the South African army as an army psychiatrist with the rank of captain. In 1947 he successfully ended up in New York City with his wife Laura and his children Stephen and Renate, along with a European middle-class education, a classic formation in psychoanalysis and a migrating experience. In 1951, thanks to Hefferline’s and Goodman’s contributions, Freidrich Perls wrote the book Gestalt Therapy: Excitement and Growth in the Human Personality, a fundamental work for Gestalt Therapy
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The 1960s and their hippie moments were for Freidrich Perls a kaleidoscope of experiences
which will be officially founded in 19528 together with the first Gestalt Institute in New York. From 1952 till 1964 Freidrich Perls decided to spread Gestalt theories and techniques by traveling a lot all around the States, going back to Europe and also to Japan where he intended to get a deeper knowledge of Zen meditation. In 1957 in his search for new experiences he also started his ‘psychedelic’ trips. In fact, the 1960s and their hippie moments were for Freidrich Perls a kaleidoscope of experiences; he went to Israel where he spent some months in a village of young artists and beatniks; then, he passed ten months in a Zen monastery «just to give a glance»9; eventually he started a new experience in Esalen (California) where, from the 1964 till 1969 he developed spectacular and impressive therapeutic techniques like the well-known hot seat, creating what he called his «circus»10. In 1969 he moved to Canada, Vancouver Island, near Lake Cowichan, where he founded an Israelian Kibbutz-like community (the Gestalt Kibbutz) where sharing and living the everyday Gestalt was possible. In 1970 at Chicago hospital he died due to cardiac failure.
Laura Polsner Perls (Lore Polsner) She was born in Baden, Germany, in 1905 and died due to thyroid issues in 1990 in Pforzheim, Germany. She had a migrating life which started and ended in her own homeland, after traveling across continents and oceans. Laura, of Jewish descent, received a humanistic schooling and only 16 she became interested in psychology while reading The Interpretation of Dreams by Sigmund Freud. She graduated in Berlin and for some years she worked as assistant to Kurt Goldstein at the Veterans Brain Injury Institute,
8 «The decade from 1942 till 1952 represents “prehistory of Gestalt Therapy”, where happened the evolution from psychoanalysis to the concentration therapy» in G. Salonia (1991), Quali origini per il futuro della psicoterapia della Gestalt?, in «Quaderni di Gestalt», VII, 12, 7-19, 7. 9 S. Ginger (2004), La Gestalt. Terapia del “con-tatto” emotivo, Mediterranee, Rome, 65. 10 Ibid., 67.
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where she started her first research on food eating and assimilation, with special interest in unconscious swallowing. In 1930 she married Friedrich Perls; in 1931 her daughter Renate was born and from that moment on taking care of her children will be only on her11. In 1933 she had to flee Germany to escape from Nazi persecutions; she arrived in South Africa with husband and children and they stayed for around ten years, becoming rich and famous. In South Africa she started to refuse the use of a couch in her therapy and move her attention towards the interpretation, the respiration, the body of her patients: «this is how Gestalt began, in South Africa», she said in an interview12. In 1947 the Perls left South Africa worried about the probable rise to power of nationalists and they moved to New York, where she started to lead a first therapy group made of Paul Weisz, Paul Goodman, Elliott Shapiro and another two artists. In 1952 the New York Gestalt Institute was founded and Laura, even if she was separated from her husband, ran it. «Gestalt Psychotherapy was conceived as a global, organismic approach»13 and Laura’s life showed her ability to maintain an open mind towards diversity, just like an organism continuously interacting with the inside and the outside, with the past and the present, always reaching for the next14.
Paul Goodman He was born in New York, in the heart of Greenwich Village, at the time a gathering place for artists, the bohemian capital and the East Coast birthplace of the Beat Movement. In 1972 he died from heart attack in New Hampshire, whose state motto is «live free or die».
11 Cf. Ibid. 12 E. Rosenfeld (1986), Storia della PdG – prima parte: conversazione con Laura Perls, in «Quaderni di Gestalt», II, 3, 36-59, 38. 13 Ibid., 50. 14 Cf. E. Conte (2005), Glossario, in G. Francesetti (ed.), Attacchi di panico e postmodernità, Franco Angeli, Milan, 177-183.
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In South Africa she started to refuse the use of a couch in her therapy and move her attention towards the interpretation, the respiration, the body of her patients: «this is how Gestalt began, in South Africa» «Gestalt Psychotherapy was conceived as a global, organismic approach» and Laura’s life showed her ability to maintain an open mind towards diversity, just like an organism continuously interacting with the inside and the outside, with the past and the present, always reaching for the next
Both his parents are American Jewish of German origins. His father left the family before his birth, and he was raised by his aunts and sister, since his mother had to work to support the family. He went to a Hebrew school, where he distinguished for his free spirit and intellectual nature. He went on psychotherapy to Lowen and continued for two years; he graduated in 1931; in 1932 he started his career as a writer and teacher at the University of Chicago where he fell in love with a male student and, for his publicly defending his feeling, was fired; in 1942 he published his first novel, The Grand Piano. Since 1934 he had been interested in Gestalt psychology, analysing German books on it. Then in the 1940s he started seeing the Perls, at the beginning as one of Laura’s patients and, later, as a thinker of the Group of Seven. He wrote and published Gestalt Therapy with Perls and Hefferline in 1951. From 1953 till 1958 he made his living by working as an «independent therapist»15. In his opinion therapy is
Paul Goodman was able to mediate and integrate the old, heavy European culture with the young, free American one, to take the historical profoundness of the Old Continent into the American immediacy, to shake the rigid middle-class rules with sharp and bitter analysis of the social transformations
Something deeply instructive according to its philosophic or religious meaning and not to the academic one […]. In this perspective the world transformation and the transformation of the self go hand in hand because there is no difference between the organism and the environment around it. Becoming ourselves and changing our lives are part of the same attempt, being psychology a means of political transformation and politics a means of mentality transformation16. Paul Goodman was able to mediate and integrate the old, heavy European culture with the young, free American one, to take the historical profoundness of the Old Continent into the American immediacy, to shake the rigid middle-class rules with sharp and bitter analysis of the social transformations.
15 B. Vincent (1993), Paul Goodman e la rivoluzione culturale della Gestalt Terapia, in «Quaderni di Gestalt», IX, 16/17, 7-23, 14. 16 Ibid., 18.
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Eliott Seymour Shapiro He was born in 1911 and died in 2003 in Manhattan: a life in the Big Apple, inside promoter of great New York transformations. His own hometown paid homage to him by defining him (as it was published on the New York Times obituary)17: «He was an educator and a psychologist whose fighting against the degradation of the public school squalor and the bureaucratic lethargy drew wide attention in the Sixties», «a tumult veteran» who managed to convince the New York mayor to build a new state school in Harlem. Elliott Shapiro was Jewish and, for that reason, often attacked by anti-Semites. He uses to spar with his father from an early age. In 1927 his father died and, to pay for his studies and help his family, he held various jobs, also at night. In 1935 he started his career as a reading teacher at a Brooklyn state school; later, he taught in the children psychiatric ward at Bellevue and in 1937 he moved to the adolescent section where he remained for 11 years; in 1948 he became principal of a school for troubled children located in a hospital, offering focused education to the little patients. In 1950 he joined the future Group of Seven: for two years Elliott had been using the book Ego, Hunger and Aggression in his lectures of psychopathology at Brooklyn College, where his students used to prepare exercises «referring to their own experiences like the inner listening»18; in 1951 he started to practise as a private part-time therapist and from 1952 till 1955 and, again, in 1959 he taught at the New York Institute for Gestalt therapy. In 1954 he became director of Public School 119 in Harlem, New York City, where he will experience power relationships and racial discriminations. He became member of the Socialist Party and very active in the Washington marches of the 60’s in support of the minorities for their civil and economical rights. His contribution to Gestalt therapy was fundamental: the re-
17 www.nytimes.com, obituary 23rd February 2003. 18 J. Wysong (1991), Una storia orale della Gestalt Terapia – conversazione con Elliott Shapiro, in «Quaderni di Gestalt», VII, 12, 29-39, 35.
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His contribution to Gestalt therapy was fundamental: the refusal of authoritarianism, the right for equality, the celebration of brotherhood and the opportunity for every human being to develop his own power and talent were values he introduced in the Group of Seven with the aim to make the individual growing experiences valuable opportunities for the development of the society
fusal of authoritarianism, the right for equality, the celebration of brotherhood and the opportunity for every human being to develop his own power and talent were values he introduced in the Group of Seven with the aim to make the individual growing experiences valuable opportunities for the development of the society. In the Group of Seven, which he described as «vigorous», that happened through an «as aggressive as profound fight» where «nobody could feel safe»19. In an interview of June 17, 1985, he pointed out the unifying power of a common fighting against bureaucracy: (The Institute)… has simply ‘grown’. Each of us was strongly against bureaucracy. It was interesting, the people who were there came from different places and Jobs and had any kind of experiences, all of them felt, with no exception, that bureaucracy was evil. A some sort of chronic evil. It was clear to all of us that anything born and developed in the institute wouldn’t have been bureaucratic20. Elliott Shapiro successfully introduced the fundamental value of experience and the importance of learning by doing
Elliott Shapiro successfully introduced the fundamental value of experience and the importance of learning by doing, promoting the insertion of exercises in the text, keeping the attention focused to what is in the background, to the fighting of minorities and to the experiences of who belonged to them. He continued saying: There was always a redundant thought: yes, we should evolve all this into an institute but we need to be careful not to give the power to anyone. Nobody can be authoritarian, all of us are equal, in a way or another, we are all equal. […] The institute wasn’t created, it simply grew and Laura Perls never ran it with authority21.
19 Ibid., 33. 20 Ibid., 31. 21 Ibid., 33.
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Isadore From He was born, together with his twin brother Sam, on October 10, 1918 in a small town of North Indiana and, on the same day, a brother died of flu. On June 27, 1994 Isadore died, aged 75, «from complications during treatment for cancer […]. He had been through a period of increasingly serious illness and endured it with courage, ironical reserve and a complete lack of self-pity»22. A life which started with a precontact with death and a death which was lived with a strong post-contact23. Isadore was son of a Viennese mother and a Jewish father, a ‘second generation’ child, as he would be called now. His father emigrated to the States from Galicia in 1903; he did good business dealing with scrap iron and paper, became rich and in the 20’s started to buy real estate. Sam continued his activity while Isadore became psychotherapist almost by chance. During the Great Depression, though, his father lost almost all his properties and fell into depression, too. His participation to the Group of Seven started from a meeting with Fritz Perls, who he became patient of in 1946 in exchange for some philosophy lessons. Later Fritz sent him to his wife Laura to start a second analysis. Once he finished it in 1949, Isadore left for Paris and Europe where he stayed for a year and a half. For all his life Isadore travelled, constantly commuting from the States and the Old Continent, with alternating moments of richness and economical support to his twin brother and burglary at supermarkets.
22 M. V. Miller (1994), Introduction to the Gestalt Journal Edition of Gestalt Therapy, in F. Perls, R. Hefferline, P. Goodman (1994) (or. ed. 1951) Gestalt Therapy: Excitement and Growth in the Human Personality, cit, VII. 23 «The contact cycle or, in other words, the experience of contactpulling back from the contact, is a uniform process consisting of a four-stage progress: pre-contact (the before, where the preliminary part of the contact starts), contact (the during, where the actual contact is activated and occurring), final contact (the end, where the contact reaches its full and spontaneous completion), post-contact (the after, pulling back from the contact and from the assimilation of experience)», based on E. Conte (2005), Glossario, in G. Francesetti (ed.), Attacchi di panico e postmodernità, cit., 178.
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A life which started with a precontact with death and a death which was lived with a strong post-contact
His philosophical contribution was of fundamental importance in the writing of the theoretical assumptions of the book and, thanks to his sympathetic and active participation to the Group of Seven, facilitated the conjugation of Gestalt therapy into clinical practice. Unfortunately, he never published anything because he was «afraid of printing something which might be wrong»
On his coming back from Europe in 1950, he was invited by Perls to become a psychotherapist and go with him to California, where Perls had already started, during his absence, a therapy with his twin brother Sam. In the formation Group of Californian high-society ladies, Isadore’s role was of «the wild card, which means that when anyone was asked what he was feeling, if Perls had asked me, I would have always replied in terms of ‘here and now’»24. His philosophical contribution was of fundamental importance in the writing of the theoretical assumptions of the book and, thanks to his sympathetic and active participation to the Group of Seven, facilitated the conjugation of Gestalt therapy into clinical practice. Unfortunately, he never published anything because he was «afraid of printing something which might be wrong»25.
Paul Weisz Of the seven people, Paul’s life was the most mysterious, shrouded in the veil of oblivion. He was probably born between 1915 and 1925 from parents of German-Hungarian descent, presumably Jewish; he died in 1965 of heart attack at Paul Goodman’s. Paul was a physics researcher with a Ph.D. in medicine. He was attracted by Eastern philosophies and his passion for Zen Buddhism particularly affected Fritz Perls. His girlfriend, Lottie, was a psychiatrist at Bellevue Hospital and worked with Fritz: maybe, thanks to this collaboration, Paul becomes one of his patients. Later Fritz sent him to his wife Laura for a second therapy. Since the 50’s Paul had been member of the Group of Seven and became soon one of the teachers of the institute. He was
24 E. Rosenfeld (1987), Storia orale della PdG – parte II: conversazione con Isadore From, in «Quaderni di Gestalt», III, 5, 11-36, 18. 25 B. Müller (1992), Il contributo di Isadore From alla teoria e alla pratica della Gestalt terapia, in «Quaderni di Gestalt», VIII, 15, 7-23, 8.
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depicted by Isadore From as «a man of impeccable integrity and probably the best therapist of us all»26. Elliott Shapiro added: «Paul Weisz was very, very intelligent and well educated. In my opinion his contribution to the group was one of the best […]. Everybody respected him as a real intellectual. And I do believe he was an excellent therapist. Paul Weisz was the best»27. Fritz Perls described him as «solid and real, wise and cruel… demanding clearest and honest thinking. Never compromising in essentials»28. Laura Perls remembered him in this way: «Paul Weisz had a brilliant intelligence, was very well educated and had a critical spirit. Fritz loved to talk with him every now and then»29. His credit and his contribution to Gestalt psychotherapy were his focusing the attention of the group on here-and-now (a concept taken from Zen and Eastern philosophies) and having stressed out the importance of not separating the mind from the body in therapy. In short, a man of a synthetic balance between East and West.
He was depicted by Isadore From as «a man of impeccable integrity and probably the best therapist of us all»
His credit and his contribution to Gestalt psychotherapy were his focusing the attention of the group on here-andnow
Sylvester ‘Buck’ Eastman Also, the biography and the contribution of Sylvester Buck Eastman got lost in the history of Gestalt Psychotherapy because they are darkened by the fame of the other theorists. The information I was able to track is quite polymorphic. He was a native American of the Dakotah tribe. For them a ‘medicine man’ is a healer who uses sacred plants whose preparation and use he learns in a vision30. Wonder how many things Buck’s eyes and soul saw!
26 I. From, Preface in P. Weisz (1990), The contribution of Georg Wilhelm Groddeck, in «The Gestalt Journal», XIII, 2, 85-98, 86. 27 J. Wysong (1991), Una storia orale della Gestalt Terapia, cit., 35. 28 I. From, Preface in P. Weisz (1990), The contribution of Georg Wilhelm Groddeck, cit., 86. 29 E. Rosenfeld (1986), Storia della PdG – prima parte: conversazione con Laura Perls, cit., 52. 30 Cf. C.F. Feest (2000), La cultura degli indiani del Nord America, Könemann, Cologne.
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He was a native American of the Dakotah tribe. For them a ‘medicine man’ is a healer who uses sacred plants whose preparation and use he learns in a vision
A man, then, who had lived many lives and different identities
In 1939 he joined the Army Air Force as captain and served in few actions as squadron flight surgeon. He was shot down twice, personally living the experience of post-traumatic stress and, after his coming back home, he enrols at the university for a doctorate in psychiatry. During the war he met a young English actress who soon became his wife; they lived in New York with their two sons but, unfortunately, she died when she was just 44. In the following year he received two war medals of honour but he had always been reticent and would never brag about it with anyone. He never used his first name, he always introduced himself as “Buck”. Since the beginning he took part to the weekly meetings at the Perls’s, maybe because he was a psychiatrist or collaborator at Bellevue Hospital31: everybody mentions him in their memories, but I have found no interviews or publications with anecdotes about him, just as if his presence belonged to a ground where all the others could easily become figures. A man, then, who had lived many lives and different identities, of which his son did not and does not even know32, a man who left only his silhouette with no personal details.
Ralph Hefferline: a Gestaltist by chance He was born in Indiana in 1910 and in Indiana died in 1974. He moved to New York in 1929 and enrolled in psychology in 1930, but he had to stop his studies to make ends meet. He did it in different ways: from writing detective stories for American 31 Some people that took part at Perls’s meetings were psychiatrists of the Bellevue Hospital. Shapiro recalls the following about them: «I was convinced that no one else would be considered with respect in the professional sector. Regardless of our position, we were probably all seen like loose cannon», in J. Wysong (1991), Una storia orale della Gestalt Terapia, cit., 33. 32 During my research I found a request for information coming from Buck’s son to war comrades of his father. He wrote an interesting anecdote, that shows, in my opinion, a beginning interest of his father for Gestalt Psychology, born during his war experience: «For example he mentioned the optical illusion that flack always looked like it would hit you as it came up, only to disperse around you as it got closer».
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tabloids to advertising. He finally graduated and in 1943 he became professor of psychology at Columbia University. In 1946 started a therapy with Fritz Perls and in 1948 approached the Group of Seven but never became its member. At Columbia University employed his students to study the unconscious human learning. For that reason, is co-author of the book Gestalt Therapy, with the charge for the practical section; the same exercises present in the book became the tests of his further studies. Shapiro described him as «a strange guy who took part to the group only at the end […]. He never gave any contribution. He remained silent and nobody said anything about that either. He looked like a piece of the furniture. And then gradually he abandoned Gestalt Therapy»33. As Hefferline’s wife recalled, after Perls’s departure from New York, Ralph reduced his visits. His experimental nature took him to Behaviourism, which he became a bold supporter of in the following years. It is fascinating to identify in this man the coexistence of such different orientations of psychotherapy, always moving towards the borders of human psyche.
From life stories to hermeneutics34 The fascination of the context, the net of relationships and the pre-contacts of the Group of Seven made me write this article, trying to track meaningful correspondences among their migrating experiences and the development of Gestalt therapy and to discover the growth rings, from roots to leaves, of such a flourishing, vital therapy which is so closed to the human being. The life stories of this group are all characterized by having taken place not in its members’ countries; by having enriched their own cultural belongings with new background elements; by
33 J. Wysong (1991), Una storia orale della Gestalt Terapia, cit., 35. 34 Hermeneutics is a branch of philosophy that aims at understanding thw world. Founder of modern hermeneutics Hans Georg Gadamer states that knowing a text is posible (such like a person, and therefore the patient, that is the other from oneself) only within our relationship with it (or him/her), without exclusing neither the history of this relationship nor the context of where it was born or its (or his/her) perception.
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The life stories of this group are all characterized by having taken place not in its members’ countries; by having enriched their own cultural belongings with new background elements
Principal human characteristic of being «an organism of great power and efficiency» «The “human nature” is a potentiality»
an extreme flexibility which influenced their assimilating ability; by the creativity which each of them, within his/her own ethnic, religious or sexually oriented minority, fostered a change in the society and the evolution of the common well-being. All this came true thanks to the principal human characteristic of being «an organism of great power and efficiency»35, deeply flexible and able to face any environmental change and dire situation. «The “human nature” is a potentiality»36 and the development of such a potential allowed the co-building of an even wider alternative of a high social meaning and to the ground well-being oriented: the birth of Gestalt psychotherapy.
Migrating added values in the Group of Seven In my opinion, the image of this Self-Other37 movement is represented by the migrating stories of its founders. Friedrich Perls, for example, is the one who, within his migratory route38, with curiosity collected events, contacts, relationships and experiences to mix them in a vital, always running wheel to stimulate the never ending transformation of the group. He lived a chameleon changing process in the acquisitions and the losses of his pieces of identity in his search for true Gestalt: stateless in unknown lands. Laura Perls, on the contrary, was the bound with the Heimat39, inside the constant call to her European, humanistic, family
35 F. Perls, R. Hefferline, P. Goodman (1994) (or. ed. 1951), Gestalt Therapy: Excitement and Growth in the Human Personality, cit., 89. 36 Ibid.,97. 37 Jacques Berque, in Mémoires des deux rives, writing about immigration, thinks that: «it is an in-migration: an internal journey through the Other and crossing the Other on my own». 38 «It is important to remember that when a person moves in a strange land, becomes automatically the first of the sire line, a kind of founder», in H. Salmi (2011), Etnopsichiatrie: l’alterità culturale nelle pratiche cliniche – dispositivi di cura e di mediazione per migranti, L’Harmattan Italia, Torino, 13. 39 “Heimat” is a German word that means ‘native country’ or ‘homeland’, a place where a person feels at home or with a strong emotional connotations or where people ground identities and roots. Cf. AA.VV. (1991), Das Pons Wörterbuch, Zanichelli/Klett, Bologna.
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and Gestalt roots. She was the one who always guided the group members back to their origins, to a safe port after their overseas crossings, allowing them to have a lineage. She was the connecting ring between before and after, a memento of the present and a support for the next. Paul Goodman, instead, is a third or fourth generation40, that is the pure transformation of several cultural identities: a quick, creative circle of destruction and synthesis of different, at times incompatible, belongings with the risk of living in a suspended, even if absolute, freedom of his own self. It is thanks to Paul Goodman that Gestalt therapy could realize its own originality and be known all over the world. Elliott Shapiro represented, through his bloodline, the positive product of the migrant’s social redeeming: the fight and the perseverance for success; the clarity of his own needs and the strong support to his own beliefs; the direction to take in life and in Gestalt psychotherapy; the opposition to discrimination, to deliberate negation of any environmental opportunities. Thanks to him the experience and the learning by doing became the milestones of Gestalt in the parallel care for a more and more nourishing ground. Isadore From embodies the wit and the cunning of the second generation: it is the destiny of who alternatively moves from luck to loss, from money to misfortune, from here to somewhere else. It is the questioning of his own roots in a journey to the centre of the Earth to rediscover them and come back with them in his hands. Isadore reminded the Group of Seven of the value of words, the importance of the clinic. Paul Weisz was the original matrix; the eastern calm, peculiar to who had travelled a lot and finally got to a new place where to be lulled. He is the strength of the ancestors which protect the bloodline and blows into the soul of who is willing to accept it.
40 «Belongs to the second and the third generation [immigrants, editor’s note] facilitate the search of the ground, the return of the negation or the repression, to develop new perspectives and integrated models», in G. Salonia (1990), Karen Horney e Frederick Perls: dalla psicoanalisi interpersonale alla terapia del contatto – la prospettiva di un terapeuta della Gestalt, in «Quaderni di Gestalt», VI, 10/11, 35-41, 41.
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Laura Perls was the one who always guided the group members back to their origins
Paul Goodman, instead, is a third or fourth generation, that is the pure transformation of several cultural identities
Elliott Shapiro represented, through his bloodline, the positive product of the migrant’s social redeeming
Isadore From embodies the wit and the cunning of the second generation
Sylvester ‘Buck’, was the mystery of the past and the unknown of the future, the metaphor of how his footprints, acquiring consciousness, can change its shape but maintain its essence
Into Gestalt psychotherapy Paul brought order and balance between the world of above and the world of underneath, between thought and emotion, between the right and the left hemispheres in a spherical synthesis of man-universe relationship. Lastly, Sylvester ‘Buck’, was the mystery of the past and the unknown of the future, the metaphor of how his footprints, acquiring consciousness, can change its shape but maintain its essence. He was the bound with the invisible41 which covers everything silently and unconsciously. He was the finishing line of what Gestalt psychotherapy became and the starting point of new theoretical impulses.
Leaves and buds If «talking about our origins is a way of talking about ourselves», then the analysis of what the seven roots were and what they became corresponds to the growth rings of Gestalt Psychotherapy
If «talking about our origins is a way of talking about ourselves»42, then the analysis of what the seven roots were and what they became corresponds to the growth rings of Gestalt Psychotherapy. It is a tree which is still constantly growing: various branches have grown and made leaves; some grafts have taken place spontaneously, some others forcibly in order to spread old varieties on the brink of extinction; secondary branches allow to the new buds to embrace different clinical and therapeutic perspectives. Anyhow such a vitality is intrinsically peculiar to the nature of Gestalt psychotherapy: a free spirit, an acceptance of what happens, the development of unexpressed potentialities and the banning of all those closed schemes which predefine reality43.
41 An ethnoclinic therapist works «with the person on the person», considering individual suffering, his/her ancestors, cults, deities, demons, the visible and unvisible world, etc. The unvisible world is a hauntedplace; spirits have «hardcore qualities: they can be invoked only in a world with multiple universes», in T. Nathan, I. Stengers (1996), Medici e stregoni, Bollati Boringhieri, Torino, 28. 42 G. Salonia (1991), Quali origini per il futuro della psicoterapia della Gestalt?, cit., 7. 43 M. Spagnuolo-Lobb (1998/1999), Opening Lecture, in «Quaderni di Gestalt», XIV-XV, 26/29, 12-18, 13.
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That was what made it innovative. As Giovanni Salona says, this is the only model of psychotherapy born from a group and not a single, created in a multidisciplinary perspective and the only one capable of bearing very high conflicts without getting to final separations. Born in and from rebellion, it has rediscovered the value of creativity self-assertion peculiar to any rebellion and, through rebellion, it has a relationship different from the one typical of its time when it was easy to be excommunicated or declared heretic44. In the events of Gestalt psychotherapy founders the contact cycle still remained open: the group showed how it was possible to come to an extreme differentiation but not how to get reunited. Their difficulty in overcoming their egotism45 prevented them to reach a creative solution between the affirmation and the surrender drives46. They did not trust the challenge for a different, creative choice which only Laura Perls understood: The voluntary surrendering requires sacrifice, giving up interests and entanglements to dedicate ourselves to higher values. This is the most difficult aspect of surrendering… one needs to make a choice47.
44 G. Salonia (1991), Quali origini per il futuro della psicoterapia della Gestalt?, cit., 15. 45 «Lastly, when all the grounds for final-contact are adequately prepared, there is interruption of letting go the control or the surveillance, of giving in to the behavior that would lead to growth, e.g., performing the action that he can do and that the situation calls for, or finishing off what he is making and leaving it. This is a slowing-down of spontaneity by further deliberate introspection and circumspection, to make sure that the ground possibilities are indeed exhausted – there is no threat of danger or surprise – before he commits himself. (For want of a better term, we call this attitude “egotism”, since it is a final concern for one’s boundaries and identity rather than for what is contacted)», in F. Perls, R. Hefferline, P. Goodman (1994) (or. ed. 1951), Gestalt Therapy: Excitement and Growth in the Human Personality, cit., 236-237. 46 Cf. G. Salonia (1991), Quali origini per il futuro della psicoterapia della Gestalt?, cit. 47 Ibid., 17.
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In the events of Gestalt psychotherapy founders the contact cycle still remained open: the group showed how it was possible to come to an extreme differentiation but not how to get reunited
To leave and go (back) to the origins of Gestalt psychotherapy then means to see the growth from roots to leaves
Which choice, or better, which challenger is up to Gestalt psychotherapy now? Which are the consequences, or better, the answers48? To leave and go (back) to the origins of Gestalt psychotherapy then means to see the growth from roots to leaves because, as Nelson Mandela wrote «Nothing like going back to an unchanged place makes us realize how we have changed»49.
48 «One can capture the particular flavor of Gestalt therapy by borrowing a formulation of Arnold Toynbee, who claimed that history cannot be based on the model of natural science because human actions are not a cause but a challenge, and their consequences are not an effect but a response» in I. From, M.V. Miller (1994), Introduction to the Gestalt Journal Edition of Gestalt Therapy, cit., XXII. 49 N. Mandela (1995), Lungo cammino verso la libertà, Feltrinelli, Milan.
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REFERENCES
AA.VV. (1991), Das Pons Wörterbuch, Zanichelli/Klett, Bologna. Andolfi M. (ed.) (2003), La mediazione culturale. Tra l’estraneo ed il familiare, Franco Angeli, Milan. Cavaleri P. (1990), Karen Horney e Frederick Perls: storie di eretici, in «Quaderni di Gestalt», 10/11, 35-42. Cole H. (1994), In ricordo di Isadore: i suoi primi anni, in «Quaderni di Gestalt», X, 18/19, 5-19. Conte E. (2005), Glossario, in Francesetti G. (ed.), Attacchi di panico e postmodernità, Franco Angeli, Milan, 177-183. Feest C.F. (2000), La cultura degli indiani del Nord America, Könemann, Cologne. From I. (1990), Prefazione all’articolo di Weisz P., The contribution of Georg Wilhelm Groddeck, in «The Gestalt Journal», XIII, 2, 85-98. From I. (1985), Requiem for Gestalt, in «Quaderni di Gestalt», I, 1, 22-32. From I., Miller M.V. (1994), Introduction to the Gestalt Journal Edition of Gestalt Therapy, in Perls F., Hefferline R., Goodman P. (1994)(or. ed. 1951), Gestalt Therapy: Excitement and Growth in the Human Personality, The Gestalt Journal Press, New York, VII-XXII. Ginger S. (2004), La Gestalt. Terapia del “con-tatto” emotivo, Mediterranee, Rome. Ginger S. (2005), Iniziazione alla Gestalt. L’arte del con-tatto, Mediterranee, Rome. Mandela N. (1995), Lungo cammino verso la libertà, Feltrinelli, Milan. Masquelier G. (2006), Gestalt Therapy: living creatively today, Gestalt Press, Santa Cruz. Miller M.V. (1994), Gestalt Therapy 40 anni dopo, in «Quaderni di Gestalt», X, 18/19, 21-36. Müller B. (1992), Il contributo di Isadore From alla teoria e alla pratica della Gestalt terapia, in «Quaderni di Gestalt», VIII, 15, 7-23. Nathan T., Stengers I. (1996), Medici e stregoni, Bollati Boringhieri, Turin. Perls F. (1980), La terapia gestaltica parola per parola, Astrolabio, Rome. Perls F. (1995), L’Io, la fame, l’aggressività, Franco Angeli, Milan. Perls F., Baumgardner P. (1983), L’eredità di Perls – doni dal lago Cowichan, Astrolabio, Rome. Perls F., Hefferline R., Goodman P. (1994)(or. ed. 1951), Gestalt Therapy: Excitement and Growth in the Human Personality, The Gestalt Journal Press, New York. Perls L. (1990), Nuove prospettive nella Terapia della Gestalt, in «Quaderni di Gestalt», 10/11, 7-11.
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Rosenfeld E. (1986), Storia della PdG – prima parte: conversazione con Laura Perls, in «Quaderni di Gestalt», II, 3, 36-59. Rosenfeld E. (1987), Storia orale della PdG – parte II: conversazione con Isadore From, in «Quaderni di Gestalt», III, 5, 11-36. Salmi H. (2011), Etnopsichiatrie: l’alterità culturale nelle pratiche cliniche – dispositivi di cura e di mediazione per migranti, L’Harmattan Italia, Turin. Salonia G. (1990), Karen Horney e Frederick Perls: dalla Psicoanalisi Interpersonale alla Terapia del Contatto, in «Quaderni di Gestalt», 10/11, 35-41. Salonia G. (1991), Quali origini per il futuro della psicoterapia della Gestalt?, in «Quaderni di Gestalt», VII, 12, 7-19. Salonia G., Spagnuolo Lobb M. (1988), Quale Reich influenzò Perls? Intervista a Luigi De Marchi, in «Quaderni di Gestalt», 6/7, 19-36. Spagnuolo-Lobb M. (1998/1999), Opening Lecture, in «Quaderni di Gestalt», XIV-XV, 26/29, 12-18. Spagnuolo-Lobb M. (ed.) (2001), Psicoterapia della Gestalt. Ermeneutica e clinica, Franco Angeli, Milan. Spagnuolo-Lobb M. (2011), Il now-for-next in psicoterapia. La psicoterapia della Gestalt raccontata nella società post-moderna, Franco Angeli, Milan. Spagnuolo-Lobb M., Salonia G. (1995), Introduzione all’edizione italiana, in Perls F. (ed.), L’Io, la fame, l’aggressività, Franco Angeli, Milan, 7-10. Vincent B. (1993), Paul Goodman e la rivoluzione culturale della Gestalt Terapia, in «Quaderni di Gestalt», IX, 16/17, 7-23. Weisz P. (1990), The contribution of Georg Wilhelm Groddeck in «The Gestalt Journal», XIII, 2, 85-98. Winter K. (2007), Paul Goodman’s Gestalt Therapy, University of Michigan, Ann Arbor. Wysong J. (1991), Una storia orale della Gestalt Terapia – conversazione con Elliott Shapiro, in «Quaderni di Gestalt», VII, 12, 29-39.
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WEBSITES
http://blog.centrodefabula.com www.claudionaranjo.net www.gestalt.de/knapp_hefferline.html www.gestalt.org www.gestaltcleveland.org www.gestaltherapy.it www.gestaltpsicoterapia.it www.gestalttheory.com www.gestalttherapy.org www.newyorkgestalt.org www.nytimes.com www.paulgoodmanfilm.com www.poetryfoundation.org www.sonoma.edu (The Gestalt pages)
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Abstract The article arises from an odd discovery, the outcome of an anthropological comparison between the principles of Gestalt Therapy and those of ethnopsychiatry, aimed at probing the points of contact and separation of the two treatment methods. By examining the biographies of the Group of Seven, it comes to light how Gestalt Psychotherapy was co-built by the founders, whose life stories were rooted in different migration paths, which were either experienced actively as deliberate choices or as second generations. Hence, the power of their diversity, the strength of their memberships and affinities stands out, as well as the conflict, even aggressive, that generated Gestalt Psychotherapy. There was a vital exchange between inside and outside, between I and Thou, within the “between”, leading to the overthrow of subjectivity, which at times because background and at times characters of diversity. From roots to leaves of Gestalt Psychotherapy to support Gestaltist’s growth of today and to remind him/her the identity has to be nourished with otherness in order to exist in the challenge of post-modernity.
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Hypochondria
SOCIETY AND PSYCHOTHERAPY
HONESTY AS THERAPEUTIC COMPETENCE by Giovanni Salonia
Since it is about a relationship based on honesty (entrusting one’s discomfort to another person), honesty is a fundamental element of professionalism, and therefore determines the effectiveness of the therapy
For a psychotherapist, being honest is not only an ethical issue, but in many aspects a professional prerequisite. Taking care of people requires integrity and honesty, as the actual definition states. Since it is about a relationship based on honesty (entrusting one’s discomfort to another person), honesty is a fundamental element of professionalism, and therefore determines the effectiveness of the therapy. I remember how much one of my students, who was studying to become a psychotherapist, struggled with it: his background was in business and he didn’t manage to cope with the mentality of a therapist (two visions of the world and the jobs that were unable to coexist for him). Obviously, talking about a psychotherapist’s honesty can’t be limited to observing the forty-two articles of the Code of Conduct (a necessary but by far not sufficient condition). The Code of Conduct shall not be perceived as a Super-Ego setting limits or rules. Sometimes, I ask future psychotherapists provocatively: Why are sexual relationships with patients not allowed? The answers are disappointingly – and somehow alarmingly – always explained with the prohibition mentioned in the Code of Conduct. Behaving with honesty only to respect rules perceived as external ones (ego-dystonic) show a moral and relational immaturity. Moreover, it is well-known that those rules that are not felt deep down inside are the first ones to be disobeyed; and even if they are observed, they produce repression and resentment. An ancient medieval wisdom says: bonum quia bonum aut bonum quia iussum? What is good is within oneself (and, therefore, doesn’t come from the rules, but is intimately connected to our deepest wishes) or is it something that remains external and has to block our instincts from the outside? What one needs is a path of genuine listening and contact with him/ herself, in order to find his/her yearning for the good, which is also necessary for external rules. For a therapist, this means the discovery/acquisition of the fact that the real regulative matter doesn’t come from a Super-Ego, from defensive inhibition or
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codes, but rather from being in a relationship and from fully experiencing the rules that define such relationship. Those who are learning a new language know that grammar and syntax are not requests imposed externally, but internal rules linked to the wish of being able to communication with other linguistic worlds. The poet is not a prisoner of semantic and grammatical rules, but if he wants to communicate, he can’t abolish grammar: he has to re-invent and re-design it. It is about establishing a “creative adaptation” which goes beyond self-referential creativity (denying the other) and passive adaptation (silencing his own subjectivity). Let’s now touch upon some content about the honesty of a psychotherapist. 1. A psychotherapist is honest, when he/she accepts that the therapeutic relationship is triadic rather than dyadic. Indeed, the basic importance of the Code of Conduct is to remember therapists that they are taking care of the patient on behalf of the community. The symbolic, but decisive presence of the “third” in the therapeutic setting ensures effectiveness and validity. The ‘third’ in therapy can be identified in many forms: civil society, therapeutic model and school of thought, supervision, co-therapist. After all, even when growing, each parentchild dyad features its validity and effectiveness in the co-parental triangle: we know that one is ‘parent-of-a-child’ when being ‘parent-with-the-co-parent’. Thinking that we are the sole saviours or unique therapists for a patient is not honest and doesn’t help in the patient’s healing or improvement path. 2. Accept that the patient remains a patient and you don’t establish any other kinds of relationship during therapy. I sometimes joke around with my therapist-students: if the best doctor asks you to assist him in therapy (or if he sends his daughter to you) … you missed the chance to be taken care of by him! You become a therapist to look after the patient and not to take advantage of the patient. Hence, honesty means for example avoiding to ask for information that could be useful for you from a personal (rather than a therapist’s) point of view. In other words, don’t ‘use’ the established (therapeutic!) relationship for yourself. I recall a student of our specialization school, who
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A psychotherapist is honest, when he/she accepts that the therapeutic relationship is triadic rather than dyadic
Accept that the patient remains a patient and you don’t establish any other kinds of relationship during therapy
The honesty with the patient requires the therapist to be continuously honest with him/herself
was quite well-known in her city – she already was a therapist, but of different approach. She asked me for a supervision to understand whether she should take part in some performances one of her patients (a famous actor) offered to an elite group in his villa from time to time. It was clear to both of us that her participation would have been negative for the patient, as he would have confused admiration with being looked after. In this case, honesty was for the student to ask herself: why do I want to take part? Sometimes, even if we are expert therapists, it’s difficult to realize that the risk to wield power over a patient, even ideological, is very high (the patient becomes… a person to persuade). A patient said to his psychoanalyst (it happened in the US): «Well, I realized that you are Republican». The therapist was surprised and nearly irritated, and replied: «But I behaved in a fair way. I’ve never mentioned it». The patient got back very firmly: «Each time I would talk about a Republican deputy, you asked me if he reminded me of a person that was part of my history. While each time I would talk in a bad way about a Democrat, you would just nod!». The honesty with the patient requires the therapist to be continuously honest with him/herself. 3. The patient is always right (in his/her own way, at least!). Gianni takes a seat and starts the session by telling me: «I am under the impression that you are mad at me». I was genuinely surprised and reply: «I don’t think so, but I would like to listen to myself». And then, after a moment: «I can’t find any negative feeling for you, but if you say so, there must be a reason. Please try and find out when and why you had this impression». His answer was: «When you opened the door to let me in, I saw anger in your eyes». My reply: «Give me a second to listen to myself». And then I realized what was happening: he was right after all. When I heard the bell ringing, I was focusing in reading a letter from a colleague, with whom I’d been having a very unpleasant disagreement, and I was quite irritated. I went to open the door very quickly, and the angry expression must have stayed with me. I shared the information with Gianni and he heaved a heavy sigh: «Thank God! I’m not mad». His feelings must have been discredited or ignored so many times in his life!
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Maybe the place with mayor risk for lack of honesty for therapists is the power we exercise over the definition of reality. The reason why a therapist is asked to test him/herself as a patient in the training analysis ultimately is to… learn humility. It is humility that ensures the honesty of the therapist and the treatment of the patient. When one of my patients blew up because I had forgotten to switch off my phone, fortunately my desire to ask her what it was recalling her disappeared into the background, and I told her: «Sorry, I made a mistake. You have a reason to be mad: I should have switched off the mobile phone». Only after, we talked about his excessive reaction, because in his experience, he was not easily given the power to claim his rights. The risk of pride and the need for honesty are an ‘endless’ personal therapy for therapists. In such sense, here the classic example quoting Gabbard1: around two minutes before the session ends, a patient aged 28 is telling about how she felt poor appreciation from her father’s side during a party at home; her dad gave more attention to her brother. The therapist wants to comment on this and looks at his watch to see whether he has enough time to do so. The patient notices, blows up and starts accusing the therapist of lack of interest, of listening to her only for mercenary reasons and of not being interested in her in any case. On the other hand, the therapist affirms that he watched his clock only to make sure he would have enough time to offer her a proper comment from a therapeutic point of view. There’s a harsh conflict. The patient insists on the fact that the therapist wants to ‘cover the sun with a net’ by refusing her accusations. This therapist publicly narrated such fragment of therapy (unfortunately!) as intervention model towards an ‘almost nonsensical’ patient...2
1 Cf. G.O. Gabbard (2006), Mente, cervello e disturbi di personalità (Mind, brain, and personality disorders), in «Psicoterapie e Scienze Umane», XL, 1, 9-24. 2 Cf. to this regard G. Salonia (2014), La luna è fatta di formaggio. Traduzione gestaltica del linguaggio borderline (GTBL), (The moon is made of cheese. Gestaltic translation of borderline lan-
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Maybe the place with mayor risk for lack of honesty for therapists is the power we exercise over the definition of reality. The reason why a therapist is asked to test him/herself as a patient in the training analysis ultimately is to… learn humility. It is humility that ensures the honesty of the therapist and the treatment of the patient
The risk of pride and the need for honesty are an ‘endless’ personal therapy for therapists
If he had only been honest to his patient, by saying: «You are probably right. You were telling me about your pain, while I focused on myself and on the response, I could have given you… I behaved like your father»! A simple acknowledgement of his own mistake would have been greatly useful and appropriate! I often recall the words of Isadore From3, who always used to repeat: «Be careful not to confuse and not to create confusion in patients». Back then, I thought it was the ‘devoted’ recommendation of an old man. Now I know that it is the wisdom of honesty. And it certainly applies not only to therapy!
guage), in G. Salonia (ed.) La luna è fatta di formaggio. Terapeuti gestaltisti traducono il linguaggio borderline, Il pozzo di Giacobbe, Trapani, 11-55. 3 Isadore From (1918-1994) was one of the most esteemed teachers and therapists of the ‘Group of Seven’ founding members of Gestalt Therapy (together with Fritz Perls, Laura Polsner, Paul Goodman and others). From 1981 to shortly before his death, he taught in the different locations of the HCC Gestalt Institute (Syracuse, Venice and Rome).
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Memory
READINGS
THE MOON IS MADE OF CHEESE GESTALT THERAPISTS TRANSLATE THE BORDERLINE LANGUAGE G. Salonia (ed.), 2016 Review by Adam Kincel The question has been on my mind since reading The Moon is Made of Cheese, edited by Giovanni Salonia. This book is an anthology of four articles by Salonia, Gionfriddo, Amato and Conte, based on the Isadore From’s metaphor, «the moon is made of cheese». Each of the articles turned out to be an interesting and insightful take on working with patients with the borderline language of which a cheesy moon is an example. Moving traditional psychopathology of borderline personality disorder into the sphere of the language deconstructs this often fixing and misogynistic diagnosis. At least in the UK, the term borderline is often applied to women who are “difficult patients”. Borderline language is inclusive of a wider group of patients and situations in the consulting room but makes me more anxious about how I may be constructing this language in my private life. Below, I review each of the articles that constitute the book from a personal perspective. The opening article comes from the editor Giovanni Salonia. In the first paragraph, he explains the title, providing the framework that supports and guides the reader throughout the chapter and the whole book. Borderline language becomes clearer now with each paragraph as Salonia elaborates on his method of validating clients’ observations through finding what truth they see from their perspective. In that way, he is akin to a relational way of working that accentuates an awareness of shame dynamics rather than a fixed view of the therapist. At the end of the day, direct confrontation with clients and contradicting them brings shame, and shame makes people withdrawn and anxious about connecting. As my favourite philosopher, Gadamer, says, if someone is talking to you, it is likely they have something to say. Salonia requests that psychotherapists find the meaning behind clients’ seemingly unreasonable sentences such as «the moon is made of cheese».
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In beginning to read this book, I am instantly immersed in the whole library of knowledge that it offers. Initially, I am not finding any answers to my question of whether I am borderline, but I feel sad. I realise that this book is a tribute to Isadore From, who is no longer with us. I am also aware that Salonia is a senior therapist and I am getting anxious we will lose him one day, too. How many Gestalt masters have we lost since 1951? I am in awe of what a beautiful way of recording From’s and Salonia’s legacy this book is. I am grieving Bud Feder, who died about two weeks ago, and I wish for a therapist who could hear my, «I am worried that Salonia may die» and would reply «Yes, we all are missing Bud». I guess this is the cheese on the moon that I see now. When Salonia brings the attachment style in his article, he feels «confusions and distress in not knowing what he wants, as he experiences the emotional warmth of a relationship, and therefore needs to distance himself to find himself again» (p. 33), I think that again he speaks about myself. I found myself often confused and frightened in intimacy, seeking the separation as a way to regain myself. Later, Salonia differentiates between narcissistic avoidance of intimacy due to possessive confluence and people with borderline language who need to separate to know what they want. That puzzles me. I know that I fear that my partner’s needs are going to take over and I am going to disappear, and that sounds to me like both possessive confluence and the need to know what I want. Am I both narcissistic and borderline? Coming back to the text, Salonia goes on to explain the aetiology of borderline language that he locates in the confusing messages of the care givers. These contradicting messages create a split between the experience and awareness that brings sensitivity when therapists try to interpret or increase the intimacy, for example, by being warm. As a therapist who self-discloses, I had to learn that for some clients, the intimacy that I offer is confusing or difficult in other ways. Salonia’s elaboration of the borderline language phenomena increases my awareness of why this may be the case. In Gestalt therapy, we often prioritise the experience and underestimate theory, but in the last few weeks, I have noticed a deeper sense of empathy towards the confusion some of my clients may feel
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and the impact of Salonia’s article on the way I experience and empathise. Where I differentiate from Salonia is when he talks about erotic resonance in the therapeutic situation. Although I agree that the therapeutic situation is asymmetric, and therapists should be mindful not to engage in exploitative activity with their clients, I think that erotic symmetry can in some cases add value to therapeutic explorations and may further support supervisees in bringing erotic resonance to the supervision. My fear is that his way of drafting a line not to cross can reduce the powerful discussions and explorations that sexuality offers. Would I discuss erotic resonance when borderline language is in operation? I don’t think so, but I would like to be able to bring it to my supervisor without feeling the shame of doing something wrong. While Salonia’s article brought me to the sky on the cloud of excitement, Gabriella Gionfriddo’s article that follows gives me much more ground and understanding of how these theories are located in the psychiatric and gestalt theories. She engages in various translations between theoretical worldviews and methodologies. I feel calmer and more confident that I understand the theories engaging with her work. Starting with deconstructing the DSM-5 diagnostic criteria, she brings them into relational focus and shows the connection between the world of psychiatry and the “cheesy moon” way of working. Locating the borderline language in the sensorimotor confusion (Id function), cognitive-narrative level (Personality function) and the cycle of contact gives me a more practical way of applying theory in practice. Although I don’t believe in symptoms as separated from the patient or the therapeutic relationship, I was nicely puzzled by the phrase, «symptom invites to a relationship» (p. 91). I like how it shows the meeting point between the therapist and the client and reduces the stigma that follows patients with borderline diagnosis in the psychiatric institutions. This may invite practitioners to engage with the difficulties of working with these patients rather than trying to find ways of avoiding them. Andreana Amato is the author of the third article. I feel calmed down reading the opening paragraph as she talks about the existential anguish between distancing oneself and relying on
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someone. At the end of the day, my competing needs for separation and closeness with my partner can be explained by contact and withdrawal cycles, described in PHG (1951). Amato’s article brings a number of case studies to exemplify the theory. She has an eye and pen for relational detail; for example, she can describe a client coming late to the therapy with such empathy and understanding that I do not think I would ever again get irritated while waiting for my clients. Amato’s article ends with a detailed analysis of Kenberg’s case of a borderline patient that has been provided by both the author and Salonia. Although the case and frequent interruptions by Salonia and Amato are very illustrative and educational, I had a slightly cringy sense, as if this analysis was a bit of a slaughter of Kenberg, who seems to be struggling with his client, sentence after sentence. Perhaps this dissection of Kenberg’s case is necessary for psychotherapeutic discourse, but the contrast between the two approaches seems huge and not giving enough justice to contemporary relational psychodynamic theories. Last but not least is the article by Valeria Conte, a rich elaboration on how borderline language is situated and co-created in the field. As soon as I read Conte’s moving case study of her teenage patient Giada, I photocopied the article and forwarded it to some of my supervisees working with teenagers, helping them to mature emotionally in environments that on the surface want the best for them but which, in fact, are harmful and entangling. Describing the case study year after year, Conte shows the traps and joys of developing a nurturing and boundaried relationship. I started my therapy when I was sixteen and that was both beneficial but also harmful, and I am envious of Giada’s support and Conte’s emotional availability throughout her childhood. I am missing, however, knowing more about the author herself. The article is client focused, and I would welcome having at least a paragraph about how this relationship also changed the therapist, as it is clear this was a very special relationship to both involved. The moon is made of cheese is a great publication. It is informative, moving and detailed in the theory and case examples. It integrates the relational approach with diagnostic criteria and has affected my practice not because it told me what to do,
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but because it increased my understanding and thus sensitivity towards my clients. I appreciated the contributions of Salonia, Gionfriddo, Amato and Conte, enjoying and assimilating the unique offering that each of them makes. This anthology is a must read for gestalt therapists who frequently encounter borderline language in their practices, and will constitute a reading for students of the training institute where I work.
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PUBLICATIONS JOURNAL OF PSYCHOTHERAPY (ITA/ENG)
Index
Index
Index
Editorial
Editorial
Editorial
In this issue
In this issue
In this issue
Research The anxiety of acting between excitement and transgression. Gestalt Therapy with the phobic-obsessive-compulsive relational styles Giovanni Salonia
Research Gestalt Therapy and its serious patients Valeria Conte
Research The personality-function in Gestalt Therapy Antonio Sichera
The Perls’ Mistake. Perceptions and misunderstandings of the gestalt post-Freudianism Interview to Giovanni Salonia by Piero A. Cavaleri
Theory of Self and the liquid society. Rewriting the Personality-function in Gestalt Therapy Giovanni Salonia
Art and psychotherapy The recovered body. Writings and images of a therapy I can’t write it… Eva Aster
Art and psychotherapy Borderline Border-line Annalisa Iaculo
The borderline patient: an insistent, anguished demand for clarity Interview to Valeria Conte by Rosa Grazia Romano Art and psychotherapy To Alda Merini Paola Argentino Catch my soul Giuliana Gambuzza New clinical pathways Onotherapy and Gestalt Therapy: New Applications of Pet Therapy Silvia Zuddas and Francesco Padoan
New clinical pathways Narcissus: the reflex without water The myth according to bill Viola, reflections on the narcissistic experience Giovanna Silvestri Readings Aluette Merenda
Readings Aluette Merenda, Fabio Presti
Re-reading ‘the re-discovered body’ interview to Maurizio Stupiggia ed. by Elisa Amenta Society and psychotherapy The flight of Bauman in Siracusa. Interview to Zygmunt Bauman ed. by Orazio Mezzio Readings Aluette Merenda
www.gestaltherapy.it
PUBLICATIONS JOURNAL OF PSYCHOTHERAPY (ITA/ENG)
Index
Index
Editorial
Editorial
In this issue
In this issue
Research The moon is made of cheese. Exercises of gestaltic translation of borderline language Giovanni Salonia
Research Gestalt animal assisted psychotherapy: heterospecific encounters in psychotherapy Aluette Merenda
The relational narcissistic model in the post-modern world and therapeutic work in Gestalt Therapy Valeria Conte
Intersections. Gestalt Therapy meets Ethnopsychiatry Michela Gecele
Beyond Oedipus, a brother for Narcissus Paola Aparo
New clinical pathways With you, I’m not afraid. For a re-reading of the script Panic attacks and postmodernity Annalisa Castrechini Society and psychotherapy Now moment or final contact? Meetings and comparisons with D. Stern, friend and teacher Giovanni Salonia Readings Aluette Merenda
www.gestaltherapy.it
Hypochondria