Book Review: Handbook for Theory, Research, and Practice in Gestalt Therapy

Having recently completed the near-impossible task of attempting to identify and relate for the 3^rd edition of the Handbook of Counselling Psychology the major therapeutic orientations which might be said to fit meaningfully into the 'humanistic approaches' category rather than any other, I found myself entranced by this elegant little hardback book. Creating the counselling psychology chapter reminded me that there is often more which links those of us within this broad humanistic frame than there is that divides us. At this point in the development of therapy, when we can so readily (and with good reason) feel our work is unappreciated and undervalued in the politically driven demand for evidence-based research, it is heartening to see how an international group of gestalt theorists and clinicians have found it possible to band together to make a strong case for their approach – and make it on their own terms and from a deepening of their own philosophy.

It may seem perverse to refer to a 351-page long Handbook as 'small', but the diminutive reflects both its pleasing compact size and also the affection which I felt for it as I carried it around with me. Good books, by which I mean books which in some sense 'feed' us, can come to feel remarkably familiar, and I quickly discovered my resonance with this particular text. It is worth saying (since aesthetics have a role to play in the way we relate to books as anything else) that the production quality of this text make it a delight to hold. It is beautifully constructed and formatted on thick paper. Still more importantly, it is intellectually weighty and provides that rare thing – both a sound and engaging commentary on gestalt psychology (contributors are well-respected figures within the gestalt community) and an exploration of the contribution of this approach to psychotherapy research. It is sometimes said, often in the course of that discussion of the need for evidence-based practice which seems, like white noise, to constitute the background to all our activities at present, that gestalt therapy (along with existential therapy and person-centred therapy) does not lend itself to rigorous research, does not promote research mindedness, or even is antagonistic to research. Each of these orientations has made inroads to counter such ill-informed contentions, and in doing so has begun to set out its stall with regard to the distinctive contribution it can make to our understanding of 'research'. Person-centred therapists have, arguably, been quickest off the mark in this respect. This new text provides a powerful corrective to misconceptions of the relationship between gestalt therapy and research and is, I believe, very successful in formulating what Ervin Polster refers to as 'creating the third leg of a tripod composed of theory, practice and research, promising increased balance and support for gestalt therapy's theoretical and procedural positions'.

This certainly feel like the right time for this book, and a positive response to the felt-need to stake out the ground by which to think about research in gestalt therapy may provide inspiration for existential therapists travelling a similar journey. I found Brownell et al's discussion of the need for gestalt therapy to have a 'warrant' – be seen as warranted – an engaging way to begin this journey, though personally I didn't travel very far down the theological/spiritual road with them. They state that they advocate an organized systematic approach to the evaluation of gestalt therapy that includes theory and research as means by which warrant is achieved. What follows, and constitutes the ground or case for gestalt therapy, is structured as three related sections: a discussion of science and research, a description of the method of gestalt therapy, and a vision for the establishment of a gestalt therapy research tradition.

A considerable strength of the book throughout is the case contributors make for recognition of the wider significance of concepts, chief among them 'relational thinking' for psychology and therapy generally. It is also interesting to note how, in practice, the contributors, while drawn from an international gestalt community, compliment and enhance rather than conflict with each other. As examples of this, and indicative of that material which might be of most relevance to existential-phenomenological readers, in Part One, A Ground by Which to Think About Research in Gestalt Therapy, Eva Gold and Stephen Zahn contextualize what follows by showing clearly how gestalt therapy has engaged with research, and how it needs to 'creatively adjust' to the current zeitgeist if it is to survive and flourish. They argue that gestalt therapists need to go beyond playing the 'empirically validated' game in order to conduct real world research which is of relevance to the problems of living faced by clients. Paul Barber and Philip Brownwell, in their chapter on Qualitative Research build on this foundation to 'illuminate a journey of qualitative inquiry through the imaginative study of a team of gestalt trainers'. In so doing, they also provide a concise guide to qualitative research methodologies, and the philosophy which informs each. Part Two, A Method Worth Investigating, presents contributions by, among others, Gary Yontef and Talia Levine Bar-Yoseph on Dialogical Relationship, and Tod Burnley and Dan Bloom on Phenomenological Method. It is always refreshing to see our chosen way of working as it is used by therapists from a different orientation, particularly when, as in the case of gestalt therapy, it is its cornerstone. At some points while reading Burnley and Bloom I felt the similarities far outweighed the differences; I could quite easily see the following quote, for instance, as a description of working with aspects of self construct and sedimentation:

The phenomenological method in Gestalt therapy involves a process that seeks to discover how the client's beliefs, and her understanding of the events and persons in her life, function in the client's own organization of experience, and therefore how they function as the ground of her cognitive, emotional, and behavioural responses to current and ongoing situations. As these things come more clearly into the client's awareness during the therapeutic process, and as she experiments with and explores aspects of life that had seem fixed (though, in fact, they were intrinsically dynamic and mutable), her initial organization begins to "loosen", to become less stuck and more fluid as she begins to rethink old beliefs and try new behaviours. (Crocker and Philippson 2005, 69)

This serves to remind me (as Yontef and Bar-Yoseph point out) that 'the practice of gestalt therapy is systematized around interpersonal contact – relational processes – rather than around techniques'…and in this respect it shares a common heritage with existential-phenomenological therapy. As to the challenge of establishing and pursuing research congruent with and utilizing the insights of gestalt therapy, it is possible to question the extent to which the contributors, having described their way of working therapeutically, and having made explicit their concerns about how research is conducted, have been able to go on to present specific ways of doing research which honour the best of gestalt theory and gestalt therapy. In some respects this book closes in the midst of this very important debate. Having said this, the positive aspect is that it closes in an energized place in which the possibilities and opportunities themselves are highlighted and the journey has begun.

Reference

Crocker, S., and Philippson, P. (2005). Phenomenology, existentialism, and eastern thought in gestalt therapy. In Wold, A. and Toman, S. (eds) Gestalt Therapy: History, Theory and Practice. London: Sage.

Simon du Plock

Trauma and Human Existence: Autobiographical, Psychoanalytic and Philosophical Reflections

Robert Stolorow. (2007). The Analytic Press. £12.50.

Just because this book is small, 51 pages, the prospective reader should not imagine that it is lightweight or insignificant. The opposite is true, it is because Robert Stolorow and his colleague George Atwood have been exploring the interface between intersubjective psychoanalysis and existential philosophy for 30 years that he is able to write such a book. If his name is unfamiliar to UK readers, it is for the rather parochial reason that he is thought to be too psychoanalytic for philosophers and too philosophical for psychoanalysts.

In his book he asks two apparently simple questions – What is trauma, and existentially, what is it that is traumatized? Although only 51 pages there are 7 chapters which progressively and coherently build up his argument for the ontological nature of trauma. Quotes from the likes of Wittgenstein, TS Eliot, Keane and Bob Dylan head each chapter.

In the first chapter, 'The Contextuality of Emotional Life' he briefly reviews some of his previous work that reframes psychoanalysis as a 'phenomenological contextualism' that has a 'central focus on dynamic intersubjective fields'. Immediately this takes us into Heidegger and his ideas on the existential ground of affectivity, 'befindlichkeit', a sense of feeling in its relational context. One is tempted to use hyphens as in 'feeling-in-its-relational-context' to reinforce its significance. Conventionally and simplistically, trauma is either about the occurrence of a usually sudden and dramatic event, and/or the inability to integrate excessive affect. This raises more questions than answers for Stolorow, and viewed intersubjectively, what defines whether something is 'traumatic' or not, he says, is our relational context i.e. the quality of attunement from caregivers. If the attunement is not present the trauma will be as if multiplied. It is bad enough for the event to have happened but even worse that it is not acknowledged by others. This has clear implications for therapy which in order to be mutative will need to acknowledge the relational simultaneity of the past, present and future so that 'the patient's emotional horizons can become widened, enriched, more flexible and more complex'. This echoes Heidegger's principle of "opening" and which is central to a notion of existential development and maturity.

Chapter 2, 'The Contextuality of Emotional Trauma', develops the theme that 'pain is not pathology'. Trauma is indeed unbearable affect but this is not all it is. It is unbearable affect that cannot find a relational home and it is this that creates a model for subsequent retraumatisation which is what has to be defended against. Resistance in therapy can then be reframed as a legitimate protection against retraumatisation. If the person does not understand and the caregivers do not either, it will lead the person to 'fail to develop the capacity for affect tolerance and the ability to use affects as guiding signals'. This reminded me of van Deurzen's (1997) idea of emotions as a compass and furthermore the circumstances whereby the compass cannot be read, or believed. What usually happens, as we all know from our clinical work, is that the traumatized person blames themselves and this makes trauma a relationally derived disorder of responsibility, when one takes responsibility for things one has no responsibility for, and/or denies responsibility for things that one does have responsibility for.

In Chapter 3, 'The Phenomenology of Trauma' he brings in an autobiographical dimension to talk about the sense of alienation and aloneness that appears as a common theme in the trauma literature. His experience, the sudden death of his wife, weaves its illuminating and moving way through the rest of the book. The point he makes here is that it is not just, or perhaps not even, the lack of the attunement of care gives that makes the difference, it is that the attunement, even if present, cannot be felt 'because of the profound sense of singularity built into the experience of trauma itself'. Other models of trauma e.g. that trauma is caused by a given event has the effect of de-personalising and reifying, while saying the trauma is a consequence of the person's fantasy blames them for it. Both are existentially inaccurate. The question then is how to existentially and intersubjectively introduce responsibility into tragedy. It is done by considering that such everyday sayings like 'See you tomorrow', are like delusions in that they are not open to question. Absolutisms like these assume that both people will be alive tomorrow in order to meet and are of course delusions which are necessary for us to carry on everyday life. The paradox is that the events that show us that the absolutisms, the delusions, we need to carry on everyday life are in fact the essence of trauma. As he says '....at any moment those you love can be struck down by a senseless random event. Not many people know that'. Trauma is 'a catastrophic loss of innocence that permanently alters one's sense of being-in-the-world'. Massive deconstruction of the absolutisms of everyday life exposes the inescapable contingency of existence on a universe that is random and unpredictable and in which no safety or continuity of being can be assured. It reduces the capacity for personal responsibility and autonomous action by crushing being and reinforcing the 'profound sense of singularity' and difference between the worlds of the traumatised and the untraumatised person. What this repositioning of trauma into ontology does is to make trauma a natural consequence of everyday contingency rather than something particular, dramatic and awful that happens to other people. Trauma can then potentially arise out of anything that reminds us of the 'universe that is random and unpredictable and in which no safety or continuity of being can be assured'. Trauma is ordinary and a part of life. We can generally take minor 'deconstruction of the absolutisms of everyday life' in our stride but not the 'massive' ones.

Chapter 4 is called 'Trauma and Temporality'. One of four vignettes used is Harry Potter who we are reminded is a 'severely traumatised little boy, nearly killed by his parent's murderer and left in the care of a family who mistreated him' and who subsequently 'encountered 'portkeys'- unobtrusive objects that transported him instantly to other places, obliterating the temporal dimension ordinarily required for travel from one location in space to another'. A similar device is used in Philip Pullman's Dark Materials trilogy. Time, we are reminded is 'thick' – in which every moment is both protentive and retentive, preserving the past and anticipating the future. Not only this but our understanding of it is intersubjectively derived. It is this 'ecstical unity of temporality' as Heidegger puts it, that is shattered in trauma. Experiences 'become freeze-framed into an eternal present in which one remains forever trapped or to which one is condemned to be perpetually returned through the portkeys supplied by life's slings and arrows' and trauma remains isolated from human dialogue because one's sense of unitary selfhood is fractured. To paraphrase Laing (1965), ones loses the sense of the 'continuity in time and a location in space' which leads to 'becoming existentially born'.(p.41). One stops being born.

In chapter 5, 'Trauma and the 'Ontological Unconscious' he defines ontological unconscious in terms of the loss of being that results when traumatised states do not find a relational home. One is lost and cut off from other beings. Inauthenticity is characterised by lostness and a 'forgetting' of ones being. Drawing again from Heidegger, he notes the significance of language, of the ability to put affect into words and refers us to an idea from Krystal (1974), echoed and developed in Stern (1985) who is not referred to here, that there are two developmental lines for affect, firstly the ability to tell them apart and then the ability to give them names and own them. Developmentally, language becomes a new medium to exchange with others and create shared meanings. It parallels the ability to see oneself as objective and we-meanings can become negotiated. But it can also fragment self experience by causing a split between the sense of a verbal more social self and the more intrapersonal sense. The infant gains entrance into a wider cultural membership at the risk of losing the wisdom of the our first language, the 'lived body' – the sense of a personal compass. Experiences resistant or invisible to verbal representation may become alienated, split off and uncoded. We are all familiar with clients who have a restricted emotional vocabulary and express their feelings non-verbally.

This process can be facilitated or disturbed by the quality of attunement of a caregiver at any time of life, not just childhood - existential birth is after all a life long process. In the absence of an attunement that facilitates, the affect will remain somatised, disowned and feared as something that can destroy the emergent 'ecstical unity of temporality'. Existential birth is interrupted.

In chapter six, 'Anxiety, Authenticity and Trauma', Stolorow notes that while Freud's distinction between fear and anxiety has some overlaps with Heidegger's, Heidegger takes it further. He says that 'trauma produces an affective state whose features bear a close similarity to the central elements in Heidegger's description of anxiety and it accomplishes this by plunging the person into a form of authentic Being-toward-death'. But this encounter with being-toward-death is itself so traumatic that it cannot be tolerated. It is a realisation that there is no ground, no substance. One is separated from one's Being. This truly is Anxiety, not fear.

This brings him to the last chapter 'Conclusions' where he helps us to understand the possibility of life after trauma. He brings light a paradox about trauma, which is 'how can something be both exquisitely context sensitive and a given a priori?' He also develops Heidegger's notion of 'solicitude' and suggests that the way that Heidegger sees authentic selfhood as found in the non-relationality of death is inadequate. Instead, quoting from Vogel (1994) he suggests that 'just as finitude is fundamental to our existential constitution, so too is it constitutive of our existence, that we meet each other as brothers and sisters in the same dark night. Thus although the possibility of emotional trauma is ever present, so too is the possibility of forming bonds of deep emotional attachment within which devastating emotional pain can be held, rendered more tolerable, and, eventually, integrated'.

The ontological paradox is that just as trauma is part of life then so is recovery from trauma.

In this small but concentrated book Robert Stolorow makes a most coherent case for an existential understanding of trauma, and it deserves to be read by anyone with an interest in trauma, existential philosophy and psychotherapy.

References

Deurzen, E. van,. (1997). Everyday Mysteries: Existential Dimensions of Psychotherapy. London:Routledge.

Krystal H (1974). Genetic View of Affects. In Integration and Self Healing: Affect, Trauma, Alexithymia (pp. 38-62) Hillsdale NJ: The Analytic Press.

Laing, R.D. (1965). The Divided Self. Harmondsworth: Penguin.

Pullman P (1995/1997/2000). His Dark Materials. London: Scholastic.

Stern D.(1985). The Interpersonal World of the Infant New York Basic Books.

Stolorow, R.D. and Atwood, G.E. (1993). Structures of Subjectivity: Explorations in Psychoanalytic Phenomenology. London: Routledge.

Stolorow, R.D., Atwood, G.E. and Orange, D. (2002). Worlds of Experience Interweaving Philosophical and Clinical Dimensions in Psychoanalysis. New York: Basic.

Stolorow, R.D. and Atwood, G.E. (2002). Contexts of Being: The Intersubjective Foundations of Psychological Life. London:Routledge.

Vogel, L. (1994). The Fragile 'we': Ethical Implications of Heidegger's Being and Time. Evanston, IL:MIT.

Martin Adams

Publications received for review

The following publications have been received for possible review. People who wish to be included in the list of book reviewers for Existential Analysis for these or other publications are requested to e-mail the Book Reviews Editor Martin Adams at adamsmc@regents.ac.uk.

• Birtchnell, J. (2002). Relating in Psychotherapy. The Application of a New Theory. Brunner Routledge.
• Gabriel, L. and Casemore, R. (eds) (2009). Relational Ethics in Practice : Narratives From Counselling and Psychotherapy. Routledge.
• Garfield, D. and Mackler, D. (2009). Beyond Medication: Therapeutic Engagement and the Recovery from Psychosis. Routledge.
• Gleeson, J., Killackey, E. and Krstev, H. (eds) (2008). Psychotherapy for the Psychoses: Theoretical, Cultural and Clinical Integration. Routledge.
• Haynes, J. (2009). Who is it who can tell me who I am? Constable.
• Kaufman, K. and New, C. (2004). Co-Counselling. The Theory and Practice of Re-Evaluation Counselling. Brunner Routledge.
• Liebmann, M. (1986). Art Therapy for Groups. A Handbook of Themes and Exercises. Brunner Routledge.
• MacCallum Sullivan, M. and Goldenberg, H. (2003). Cradling the Chrysalis : Teaching/Learning Psychotherapy Continuum.